NIH study: CMS should do more to help Part D beneficiaries with opioid misuse, overdose

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A new study from the National Institutes of Health suggests that the Centers for Medicare and Medicaid Services (CMS) can do more to prevent Medicare Part D Beneficiaries with opioid misuse disorder from dying of overdoses.

In the study, the Office of Inspector General looked at Medicare Part D beneficiaries and identified more than 71,000 of them who are at serious risk of misuse or overdose in 2017. Those beneficiaries were found to be more likely to die from an overdose or suffer some other opioid-related injury the following year.

Eleven percent of the beneficiaries at serious risk in 2017 had an overdose or adverse effect from an opioid within a year. About half of the beneficiaries at serious risk had been diagnosed with opioid use disorder or other conditions related to the misuse of opioids.

But only a quarter of the beneficiaries at serious risk received a prescription through Part D for naloxone, and only four percent of those same beneficiaries received a prescription for a medication-assisted treatment drug.

“Although opioids can be appropriate under certain circumstances, steps should be taken to mitigate the risk of misuse and overdose, especially when beneficiaries receive high amounts of opioids for long periods of time,” the OIG said in its report on the study.

The study found that most of the 71,000 beneficiaries identified in 2017 as either receiving high amounts of opioids or of potentially doctor shopping, more than 57,000, were still receiving high amounts of opioids in 2018.

“Each of these 57,604 beneficiaries received a high amount of opioids through Part D in 2018, i.e., they had an average daily morphine equivalent dose (MED) that exceeded 120 mg for at least 3 months during the year… A daily MED of 120 mg is equivalent to taking 12 tablets a day of Vicodin 10 mg or 16 tablets a day of Percocet 5 mg,” the study found. “Most of these beneficiaries (46,472) had opioid amounts that were twice that high. These beneficiaries had an average daily MED that exceeded 240 mg for at least 3 months during 2018. This is equivalent to receiving 32 tablets of Percocet 5 mg every day for 3 months.”

However, the study showed that in many cases, the following those same beneficiaries showed that incidents of doctor shopping and receiving high dosages of opioids seemed to fall. The study looked at beneficiaries with high doses of opioids who had four or more doctors and pharmacies to assess if the beneficiaries were doctor shopping. Of the 14,814 beneficiaries at serious risk in 2017 who appeared to be doctor shopping, only 2,452 met the same criterion n 2018.

The NIH said the CMS could help further lessen the risk of overdose and injury by educating beneficiaries about MAT and its coverage under the program.

“CMS plays an important role in education and awareness among beneficiaries and healthcare providers about treatment and coverage under Medicare. CMS should determine the best strategies to increase awareness among beneficiaries and healthcare providers about access to MAT drugs under Part D and under the new changes to Medicare Part B, which covers opioid use disorder treatment and MAT drugs,” the study said.

Additionally, it urged the CMS to work with the Substance Abuse and Mental Health Services Administration (SAMSHA) to develop new ways to reach out to beneficiaries and health care providers.

“For example, CMS could partner with SAMHSA to provide Part D beneficiaries with information about the specific providers in their area who can prescribe MAT drugs,” the report said. “CMS could also partner with SAMHSA to send letters to providers who serve Part D beneficiaries in areas with limited or no providers who can prescribe buprenorphine for MAT. These letters could inform providers about the need for SAMHSA-waivered providers in their area and include instructions about how to become a waivered provider.”

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