From the U.S. Government Accountability Office, www.gao.gov Transcript for: Prescription Opioids Description: In 2016, over 14 million Medicare Part D beneficiaries received opioid prescriptions. We looked at how the federal government monitors opioids prescribed through this program. Related GAO Work: GAO-18-15: Prescription Opioids: Medicare Needs to Expand Oversight Efforts to Reduce the Risk of Harm Released: November 2017 [ Background Music ] [Elizabeth Curda:] Overdoses and fatalities from misuse of opioids is reaching epidemic proportions. [Sarah Kaczmarek:] Welcome to GAO's Watchdog Report, your source for news and information from the U.S. Government Accountability Office. I'm Sarah Kaczmarek. In 2016, more than 14 million people were prescribed at least one opioid prescription through the Medicare drug benefit program known as Medicare Part D. I sat down with Elizabeth Curda, a director who worked with our Health Care team, to talk about GAO's new report on prescription opioids. I first wanted to get a clear picture of the problem at hand. [Elizabeth Curda:] Misuse of prescription opioids is a serious public health problem in the United States. It's widespread in many communities, and it's also growing. Overdoses and deaths from opioid misuse have quadrupled since 1999. Our report, it's focusing specifically on opioid prescribing in the Medicare population, seniors over 65 and some disabled people. One third of those Medicare Part D participants had opioid prescriptions in 2016 at a cost of $4 billion. And CMS, the Center for Medicare and Medicaid Services, is responsible for overseeing Medicare programs, and has set a goal for reducing harm from the misuse of opioid prescriptions. [Sarah Kaczmarek:] So, how are prescriptions for this monitored for misuse in this program, then? [Elizabeth Curda:] CMS takes a two-pronged approach. The first focuses on the enrollees in Medicare Part D. They monitor the enrollees' opioid prescriptions along three dimensions. The first is, are they taking high doses, higher than what is considered safe? The second is, are they getting their prescriptions from multiple doctors? And the third is, are they fulfilling their prescriptions from multiple pharmacies? So, it's a much narrower sort of subset of the population, that very at-risk kind of population. [Sarah Kaczmarek:] Because, if you're getting prescriptions from multiple doctors, or filling in multiple places, or getting a high dose, that's kind of a signal of maybe that's not legitimate. [Elizabeth Curda:] It might be worth taking a closer look at, and what they do is, they send lists of these folks to their private healthcare plans who provide the healthcare services to Medicare enrollees, and the private healthcare plans can take a variety of actions. They can, for example, do case management, which is contacting the doctor and saying, "Look, you've got a patient who's getting prescriptions from multiple doctors, or fulfilling from multiple pharmacies," and really try to coordinate their care better. They can also provide education to the doctor, if they are not aware that the CDC, Centers for Disease Control, guidelines have changed in terms of what is considered a safe level of opioid prescriptions. And, they can also, for individuals, restrict their access to medication so that they're not getting too much. [Sarah Kaczmarek:] Okay, now you said this was a two-pronged approach, so tell me also about how they monitor the provider. [Elizabeth Curda:] CMS uses a contractor to monitor the providers' prescribing patterns. They identify providers who prescribe the most high-risk drugs, for example. This includes opioids, but it doesn't separately identify them. They analyze data for potentially fraudulent prescribing. For example, they might look at a provider who has enrollees from many different zip codes or distant zip codes. And they might also look for inappropriate combinations of opioid prescriptions with other drugs that isn't medically needed. [ Background Music ] [Sarah Kaczmarek:] Given the increased attention to the opioid epidemic in the United States, I asked Elizabeth to tell me about her team's recommendations to help reduce the risk of abuse of this high-risk drug. [Elizabeth Curda:] Well, our first recommendation is that CMS routinely gather and track data on the larger population of enrollees potentially at harm because they are taking high doses of opioids that exceed the CDC's recommended limits. The second is that they should require their contractor, as they identify providers who prescribe the most high-risk drugs, to separately identify opioid drugs from that list. [Sarah Kaczmarek:] Taking a step back, this is an issue clearly affecting so many Americans. What do you see is the bottom line of this report? [Elizabeth Curda:] Well, opioid overprescribing and overdoses and fatalities from misuse of opioids is reaching epidemic proportions in our country. We hope that our recommendations can help CMS better determine if their efforts to reduce harm from opioid overprescribing are working effectively. [ Background Music ] [Sarah Kaczmarek:] Thanks for listening to the Watchdog Report. To hear more podcasts, subscribe to us on Apple Podcasts. [ Background Music ] [ Sarah Kaczmarek: ] For more from the Congressional watchdog, the U.S. Government Accountability Office, visit us at gao.gov.