Opioid use and lack of treatment continues to be a problem for Medicare beneficiaries, with an estimated 50,400 Part D beneficiaries experiencing an opioid overdose in 2021, a new report shows.
The U.S. Office of Inspector General (OIG) report is based primarily on five data sources: Medicare Part D, Prescription Event Records, First Data Bank, Medicare Enrollment Database, National History File of claims and appointment data in Part C.
The overdoses recorded in the report were from prescription opioids, illegal opiates, or both. Although the OIG found nearly 50,400 Part D beneficiaries who experienced an overdose in 2021, it said the number is likely to be even higher because some may have overdosed and not received medical care. that was billed to Medicare. Another possibility is that their claims have not yet been submitted to Medicare.
An average of 4,800 beneficiaries overdosed per month in 2021. However, some months had much higher numbers. From April to July, more than 5,000 Part D beneficiaries had an opioid overdose per month. July was the highest with 5,404.
The high number of overdoses may be due to a lack of support. More than 1 million Medicare beneficiaries were diagnosed with an 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 16%.
“However, this low share may indicate that beneficiaries have challenges accessing treatment,” the OIG said.
There are three drugs for the treatment of opiate use disorder that are approved by the Food and Drug Administration: buprenorphine, methadone, and naltrexone. While buprenorphine and naltrexone are covered by Part D, methadone is not because it is not dispensed at pharmacies. May be administered or dispensed only in opioid treatment programs.
The report found some positive trends, mainly in the number of opioids prescribed. The number of Medicare Part D beneficiaries who received at least one prescription opioid in 2021 dropped to about a quarter of beneficiaries, a decrease from previous years, according to the OIG. In 2016, this number was 33%.
In addition, the number of beneficiaries receiving large amounts of opioids—an average morphine-equivalent dose of more than 120 mg per day for at least three months—through Medicare Part D also decreased. In 2020, their number exceeded 225,000 beneficiaries. In 2021, fewer than 200,000 beneficiaries received large amounts of opioids. The Centers for Disease Control and Prevention recommends that prescribers avoid increasing doses to 90 mg or more per day.
Although there were some positive insights, the OIG is still calling for action on the opioid crisis in the US
“There is clearly still cause for concern and vigilance, although some positive trends are emerging. “Opioid use monitoring and access to opioid use disorder medications, as well as naloxone, are critical to addressing the opioid crisis,” the OIG report said.
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