Frequently Asked Questions

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FAQ

What is CMS doing in addressing opioid overutilization, including in the Medicare Part D program?

Prescription drug abuse is a serious and growing problem nationwide. CMS is committed to protecting Medicare beneficiaries and the Medicare Trust fund from the harm and damaging effects associated with prescription drug abuse. CMS takes this problem seriously and implemented more comprehensive strategies beginning in 2013 to address the overutilization of opioids in Medicare Part D while maintaining beneficiary access to needed medications.

The Medicare Part D Overutilization Monitoring System (OMS) was fully implemented on July 31, 2013, to help CMS ensure that sponsors have established reasonable and appropriate drug utilization management programs to assist in preventing overutilization of prescribed medications. For more information on CMS’ efforts to address the growing problem of abuse of opioids in the Part D program, go to http://cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2015-Fact-sheets-items/2015-11-03.html.

While this data set cannot be used to identify overutilization of prescribed medications for a given beneficiary, it can be used to conduct other types of analyses of opioid prescribing and utilization under Part D. In the dataset, the percent of total prescriber claims for opioids was 5.3% nationally. Specialists associated with pain management had high rates of opioid prescribing (>50% of claims) compared to general practitioners such as internal medicine (4%) and family practice (5%). Some individual prescribers were found to have over 80% of their claims for opioids.


(FAQ13297)

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