Opioid use and the lack of treatment continues to be a concern for Medicare beneficiaries, with about 50,400 Part D beneficiaries experiencing an opioid overdose in 2021, a new report shows.
The U.S. Office of Inspector General’s (OIG) report is mostly based on five data sources: Medicare Part D Prescription Drug Event records, the First Databank, the Medicare Enrollment Database, the National Claims History File and Part C Encounter Data.
The overdoses recorded in the report are from prescription opioids, illicit opioids or both. While OIG found nearly 50,400 Part D beneficiaries who experienced an overdose in 2021, it said the number is likely to be even higher as some may have overdosed and not received medical care that was billed to Medicare. Another possibility is that their claims have not been submitted to Medicare yet.
An average of 4,800 beneficiaries experienced an overdose per month in 2021. However, some months had a much higher number. From April through July, more than 5,000 Part D beneficiaries had an opioid overdose per month. July had the highest, with 5,404.
The high number of overdoses could be due to a lack of support. More than 1 million Medicare beneficiaries were diagnosed with opioid use disorder in 2021. But despite this high number, only 18% received medication to treat their disorder. However, this is still an increase from 2020, which was at 16%.
“Nonetheless, this low proportion may indicate that beneficiaries have challenges accessing treatment,” OIG said.
A Deep-dive Into Specialty Pharma
A specialty drug is a class of prescription medications used to treat complex, chronic or rare medical conditions. Although this classification was originally intended to define the treatment of rare, also termed “orphan” diseases, affecting fewer than 200,000 people in the US, more recently, specialty drugs have emerged as the cornerstone of treatment for chronic and complex diseases such as cancer, autoimmune conditions, diabetes, hepatitis C, and HIV/AIDS.
There are three medications to treat opioid use disorder that are approved by the Food and Drug Administration: buprenorphine, methadone and naltrexone. While buprenorphine and naltrexone are both covered by Part D, methadone is not because it is not dispensed at pharmacies. It can only be administered or dispensed at opioid treatment programs.
There were some positive trends found in the report, mainly in the number of opioids being prescribed. The number of Medicare Part D beneficiaries who received at least one prescription opioid in 2021 fell to about a quarter of beneficiaries, a decrease from prior years, according to OIG. In 2016, this number was 33%.
Additionally, the number of beneficiaries receiving high amounts of opioids — an average morphine equivalent dose of more than 120 mg a day for at least three months — through Medicare Part D also decreased. In 2020, the number exceeded 225,000 beneficiaries. In 2021, fewer than 200,000 beneficiaries received high amounts of opioids. The Centers for Disease Control and Prevention recommends prescribers avoid increasing dosages to 90 mg or more a day.
Although there were some positive insights, OIG still is calling for action on the opioid crisis in the U.S.
“There is clearly still cause for concern and vigilance, even as some positive trends emerge. Monitoring opioid use and access to medications for the treatment of opioid use disorder as well as to naloxone are critical to addressing the opioid crisis,” OIG said in the report.
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