Opioids & Medicare Part D: A Quiz on Questionable Prescribing

Apr 9, 2018

  • Opioids & Medicare Part D: A Quiz on Questionable Prescribing

  • Question #1: What percentage of opioids prescribed to Medicare Part D recipients were schedule II or III controlled substances?

  • Answer: C. 80% of prescribed opioids were DEA schedule II or III substances, which have the highest potentional for abuse. 

  • Question #2: In 2016, how much did Medicare Part D pay for Schedule II and III opioids? 

  • Answer: C. Spending by Medicare Part D increased by 165% in 2016 to $3.9 billion for Schedule II and III opioids. 

  • Question #3: Which opioids were most commonly prescribed in 2016 to Medicare Part D recipients? 

  • Answer: C. Tramadol. 

    Number of  prescriptions written in 2016 for schedule III opioids:
    Hydrocodone-acetaminophen (325 mg) combinations:

    • 5 mg: 11.3 million
    • 10 mg: 11.2 million
    • 7.5 mg: 5.7 million

    Oxycodone-acetaminophen (325 mg) combinations:

    • 5 mg: 5 million

  • Question #4: Which two states had the highest proportions of beneficiaries receive at least 1 opioid prescription? 

  • Answer: A. Alabama ranked first with 46% of beneficiaries receiving at least 1 opioid prescription and Mississippi trailed behind at 45%. 

    For the other states:

    • Arkansas: 44%
    • Oklahoma: 42%
    • Tennessee: 42%
    • Louisiana: 42%

  • Question #5: Research shows that the risk of opioid dependence increases substantially for patients who continuously receive opioids for how long?

  • Answer: B. 3 months. In 2016, 5 million beneficiaries received opioids for 3 months or more. Of those, 3.6 million received opioids for 6 months and around 610,000 received them for an entire year. 

  • Question #6: Approximately 500,000 beneficiaries received "high" amounts of opioids through Medicare Part D (excludes members being treated for cancer or receiving hospice care). What was the average daily MED given to these patients for at least 3 months? 

  • Anwer: C. A daily MED of 120 mg = 12 tablets of hydrocodone (10)/acetaminophen (325) or 16 tablets of oxycodone (5)/acetaminophen (325). These doses exceed the 90 mg daily MED level that CDC says should be avoided even in patients with chronic pain.

  • Question 7: True or false? The most commonly prescribed opioid for those beneficiaries identified as receiving high amounts was oxycodone 20 mg. 

  • Answer: B. False. Oxycodone 30 mg was the most commonly prescribed opioid for Medicare Part D recipients. 

  • Question #8: True or false? The CDC Guidelines for Prescribing Opioids for Chronic Pain identifies an average daily MED > 300 mg for 12 months, an "extreme amount"
    of opioid consumption. 

  • Answer: B. False. A daily MED of > 240 mg for an entire year qualifies as an extreme amount. 

    Per the CDC, average daily MED:

    • Level to avoid: ≥90 mg
    • High amount: >120 mg for 3 months
    • Extreme amount: >240 mg for 12 months

  • Question #9: Which of the above identifies a patient who is "doctor shopping" as defined by CMS?

  • Answer: C. A patient is considered "doctor shopping" if they have received an average daily MED over 120 mg for 3 months, had 4 or more prescribers, and used 4 or more pharmacies. 

  • Question #10: One Medicare Part D beneficiary received opioid prescriptions from 42 different prescribers and filled them at 37 different pharmacies in one year. During one month, as a result of prescriptions from one prescriber, the beneficiary received how many pills of oxycodone, hydromorphone, and morphine combined?

  • Answer: A. The beneficiary received prescriptions for a total of 2,330 opioid pills from a single provider in one month. 

In its efforts to police fraud, abuse, and misuse of opioids, the Office of the Inspector General (OIG), a division of the US Department of Health & Human Services, has focused on prescriptions for these extremely high-profile drugs obtained under Medicare Part D, the drug benefit for Medicare recipients. OIG issued a data brief in July 2017 titled Opioids in Medicare Part D: Concerns about Extreme Use and Questionable Prescribing.

The 10 questions in the slides above are based on the report.  Some of the questions may not challenge what you know, but we think you’ll be surprised by the answers to others. Good luck!

 

For more information, check out the full report: Office of Inspector General, US Dept of Health & Human Services. Opioids in Medicare Part D: Concerns about Extreme Use and Questionable Prescribing. Washington, DC: US Dept of Health and Human Services. 2017. HHS OIG Data Brief OEI-02-17-00250

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