FACT FILE: OIG flags opioid misuse, questionable prescribing in Medicare Part D | Behavioral Healthcare Executive Skip to content Skip to navigation

FACT FILE: OIG flags opioid misuse, questionable prescribing in Medicare Part D

August 10, 2017
by Tom Valentino, Senior Editor
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With concerns about fraud, abuse and misuse of opioids looming, the U.S. Department of Health and Human Services Office of Inspector General (OIG) recently released a study of Medicare beneficiary data that identifies cases of extreme use, questionable prescribing and doctor shopping. The OIG research analyzes 2016 opioid utilization among Medicare Part D beneficiaries. Part D, the optional prescription drug benefit for those on Medicare, covered 43.6 million Americans last year.


By the numbers

  • 1 in 3: 14.4 million—or one-third of Part D enrollees—received an opioid prescription.
  • $4.1 billion: Cost of 79.4 million opioid prescriptions written for these beneficiaries. The most commonly prescribed opioids were tramadol, hydrocodone-acetaminophen (including Vicodin) and oxycodone-acetaminophen (including Percocet).
  • 501,008: Beneficiaries who received high amounts of opioids through Part D, not including beneficiaries with cancer or those in hospice care. High amounts are defined as an average morphine equivalent dose (MED) of greater than 120 mg per day for at least three months. The Centers for Disease Control and Prevention recommends patients with chronic pain avoid exceeding a 90 mg MED level.
  • 89,843: Beneficiaries who are at risk of opioid misuse or overdose. Beneficiaries were deemed to be at risk if they received extreme amounts of opioids or if they appeared to be doctor shopping. A total of 69,563 beneficiaries received extreme amounts (an average daily MED that exceeded 240 mg for a year), while 22,308 were identified as potentially doctor shopping (receiving opioids at an average MED of more than 120 mg for at least three months while having at least four prescribers and four pharmacies) in 2016.
  • 115,581: Prescribers who ordered opioids for at least one Part D beneficiary deemed to be at serious risk for opioid misuse or overdose. Beneficiaries were identified as such if they had received extreme amounts of opioids or appeared to be doctor shopping.
  • 401: Prescribers who wrote opioid prescriptions for the highest number of beneficiaries considered to be at serious risk. This group accounted for 256,260 prescriptions for opioids, costing Part D $66.5 million. Of the 401 prescribers in this group, 81 were identified as nurse practitioners and 52 were physician assistants.


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