GAO: CMS failed to identify thousands of Medicare beneficiaries at risk for opioid addiction

A recent Government Accountability Office report urged CMS to improve its oversight of opioid use among Medicare Part D beneficiaries. GAO believes CMS's prescribing guidelines, which depend on prescription monitoring data from private groups that implement Medicare drug plans, omit many Medicare patients at-risk for addiction and misuse.

A recent Government Accountability Office report urged CMS to improve its oversight of opioid use among Medicare Part D beneficiaries. GAO believes CMS's prescribing guidelines, which depend on prescription monitoring data from private groups that implement Medicare drug plans, omit many Medicare patients at-risk for addiction and misuse. While CMS calculated that 33,223 Medicare recipients were at risk of opioid overutilization, GAO concluded more than 727,000 enrollees in Medicare's prescription drug program in 2015 were at risk due to opioid prescriptions not aligned with CDC prescribing guidelines. "CMS oversees the prescribing of drugs at high risk of abuse through a variety of projects, but does not analyze data specifically on opioids," wrote the authors of the GAO report. "However, GAO found that CMS does not identify providers who may be inappropriately prescribing large amounts of opioids separately from other drugs, and does not require plan sponsors to report actions they take when they identify such providers. As a result, CMS is lacking information that it could use to assess how opioid prescribing patterns are changing over time, and whether its efforts to reduce harm are effective." GAO advised CMS to collect information on beneficiaries receiving high doses of opioids, identify providers who write high amounts of opioid prescriptions, and direct plan sponsors to report potentially inappropriate provider prescribing practices.