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Medicare Part D Opioid Impact Evaluation


  • The national opioid crisis hits Medicare Part D beneficiaries.
  • CMS ensures Medicare sponsors set up controls to prevent misuse.
  • Abt’s evaluation will help CMS improve its policies and systems.
The Challenge

The misuse of opioids is a national crisis. One aspect of the larger problem relates to prescription opioids for Medicare beneficiaries. The Centers for Medicare & Medicaid Services (CMS) needs to evaluate trends to fight potential fraud, waste, and abuse of the drugs.

The Approach

Abt is a subcontractor to L&M Policy Research, LLC on this study. We examined the extent to which Medicare sponsors implemented formulary controls, new or improved drug utilization review programs, and case-management techniques. We conducted statistical analyses to assess:

  • Changes in prescription opioid use before and after implementation of 2013 CMS controls  for prescribing and dispensing opioids
  • Changes in suspicious patterns of opioid purchasing
  • The effects of different controls implemented by sponsors
The Results

CMS saw a 26% decrease in Medicare Part D beneficiaries who are potential opioid over-users after implementing new policies. The Abt evaluation will help CMS further strengthen its policies and curb misuse.