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The Opioid Epidemic Is Plaguing Medicare Part D

By  Senior Market Advisors  on September 13, 2017

The Opioid Epidemic Is Plaguing Medicare Part D

In 2016, one out of every three Medicare prescription drug beneficiaries received an opioid. 3.6 million of those people held their prescription for at least six months. Anyone who uses an opioid for that long is extremely likely to develop an addiction.

Most of this is due to “doctor shopping.” This means that Medicare beneficiaries are visiting multiple doctors and receiving multiple prescriptions, then filling those prescriptions at different pharmacies. It allows them to “discreetly” hold way more drugs than they actually need. Some are then selling those drugs for profit, and others are taking them and developing addictions. Thanks to updated Medicare monitoring methods, seniors and Medicare eligibles may not be able to do this for long.

What Are The Effects?

When a person becomes addicted to a drug, they have cravings for it that make it impossible to function without it. Then, even when they’re on the drug, there are side effects like exhaustion, nausea, stomach pains, dizziness, and breathing problems. Still, those who are addicted would rather live with the side effects than go through withdrawals. Withdrawals can leave users feeling extreme anxiety, constant shaking, nausea and vomiting, and severe fatigue.

Aside from the addictive effects for beneficiaries, opioid abuse costs Medicare and Medicaid millions in unnecessary costs. Those funds could be used for medically necessary drugs and treatments, instead of for supporting addictions. Without opioid addictions, Medicaid and Medicare would be able to lower their budgets.

How Can We Fix This?

Pharmacists are trying to find ways to make these drugs less abusable, like making them harder to crush and snort or inject. However, it’s nearly impossible to avoid people taking too many of their prescribed pills. The best way to “fix” this epidemic is to better regulate it.

Back in 2014, CMS enacted a rule that required any provider who prescribes medications to seniors and Medicare eligibles to register with CMS to allow better monitoring. Over time, this will help prevent doctor shopping and ultimately lower a number of pills any one person is able to receive legally. Now, there are state laws that require pharmacies to cross-check a database before handing out opioid prescriptions. This ensures that the person has not already received the same drug from another pharmacy.

Earlier this year, CMS released a document that outlines their progress in solving this problem. Through careful monitoring, they were able to detect when seniors and Medicare beneficiaries filled prescriptions at multiple pharmacies and prevent doctors from prescribing more. From 2011 to 2016, there was a 61% decrease in opioid abuse within the Medicare beneficiary community – but there is still a lot of work to do.

What Can You Do?

If you suspect opioid abuse from a prescribing doctor or pharmacy, report it as Medicare fraud, waste, and abuse. Report any suspicious activity to 1-800-HHS-TIPS (1-800-447-8477) or