Medicare Going in 'Right Direction' on Opioid Epidemic

Martha Bebinger, WBUR

July 12, 2019

Prescriptions for two drugs used to treat opioid addiction increased significantly from 2016 to 2018 for people on Medicare, according to a federal report out Wednesday.

About 174,000 Medicare beneficiaries received such a medication — either buprenorphine or naltrexone — to help them with recovery in 2018, according to the Office of Inspector General in the Department of Health and Human Services.

In addition, prescriptions for naloxone, the drug that can reverse an opioid overdose, spiked since 2016, rising 501% ― and that is likely an underestimate because it doesn’t include doses of the nasal spray Medicare members might have received through local programs, the OIG said.

"For now, the numbers are going in the right direction," said Miriam Anderson, lead investigator on the report. "But this is a national crisis and we must remain vigilant and continue to fight this epidemic and ensure that opioids are prescribed and used appropriately."

During the two years studied, the threat of new addictions appeared to slow. Prescriptions for an opioid through Medicare Part D decreased by 11%. The numbers of the beneficiaries considered at serious risk for misuse or overdose ― either because they received extreme amounts of opioids or appeared to be "doctor shopping" ― dropped 46%. And there were 51% fewer doctors or other providers flagged for prescribing opioids to patients at serious risk from 2016 through 2018.

The report says the OIG and other law enforcement agencies will investigate the highest-level prescribers for possible fraud and signs that some providers operate pill mills. The report mentions a physician in Florida who provided 104 high-risk Medicare patients with 2,619 opioid prescriptions.

It will be up to Medicare to follow up with patients whose opioid use suggests addiction, recreational use or resale. In one case, a Pennsylvania woman received 10,728 oxycodone pills and 570 fentanyl patches from a single physician during 2018. A Medicare member in Alabama acquired 56 opioid prescriptions from 25 different prescribers within one year.