Buprenorphine misuse and diversion risk for opioid use disorder appears to be lower in Medicare Part D OEI-02-22-00160 05-16-2023

May 16, 2023 | OEI-02-22-00160 | full report

Main results

• Nearly all Medicare Part D enrollees who received buprenorphine for the treatment of opioid use disorder received the recommended dose.
• A small number of enrollees received either very high doses of buprenorphine or received buprenorphine at the same time as high doses of other opioids.
• Most prescribers ordered buprenorphine for a limited number of Part D enrollees. Few had patterns that caused concern.
• These findings further support the recent repeal of exemptions that were in place, in part, to limit the diversion of buprenorphine.
• The report also provides baseline information and recommendations to help the Centers for Medicare and Medicaid Services (CMS) and the U.S. Department of Health and Human Services (“the Department”) work to continue improving access to buprenorphine. To do. The risk of diversion or misuse remains low.

Why OIG Conducted This Review

Opioid-related overdose deaths in the United States remain a concern, with an estimated 82,310 deaths in 2021. As the country continues to fight the opioid crisis, it is imperative to ensure access to buprenorphine to treat individuals with opioid use disorders.

Buprenorphine has been shown to reduce illicit opioid use and opioid-related overdose deaths. But there are concerns about access to this potentially lifesaving drug. Previous efforts by the Office of the Inspector General (OIG) indicate that more Medicare enrollees need treatment for opioid use disorders. The OIG found that only 18% of Medicare beneficiaries diagnosed with opioid use disorder were receiving medication to treat their opioid use disorder. In addition, black, Hispanic, and Asian/Pacific Islander Medicare registrants are less likely than white registrants to receive medications to treat opioid use disorders.

At the same time, buprenorphine (hereafter referred to as buprenorphine) for the treatment of opioid use disorders is at risk of misuse and diversion. To address this risk, providers must obtain a waiver through the Substance Abuse and Mental Health Services Administration (SAMHSA) to prescribe or administer buprenorphine in office-based settings, limiting the number of patients they can treat. had been This exemption is commonly referred to as the “DATA exemption” after his 2000 Drug Addiction Treatment Act (DATA) that established the exemption program. In December 2022, the Consolidated Expenditures Act of 2023 eliminated the exemption requirement and corresponding patient limit. This change comes in tandem with broad government efforts to expand access to treatment, in part by removing barriers.

This data brief provides information on the risk of misuse and diversion of buprenorphine in Medicare Part D in 2021, ahead of the retirement of the DATA exemption. Prescribing of buprenorphine has been limited, partly due to concerns about misuse and diversion. However, so far there is little information available about the extent to which buprenorphine can be abused or diverted in Medicare. This data overview describes buprenorphine use and reviews several measures for assessing the risk of buprenorphine misuse and diversion in Medicare.

How OIG did this review

We focused this review on Medicare Part D claims for buprenorphine indicated for the treatment of opioid use disorders in 2021, prior to the retirement of the DATA waiver. Claims for buprenorphine indicated for pain are not included. Buprenorphine, which is covered by Medicare Part D, is typically prescribed in office-based settings and dispensed at retail pharmacies.

What oig found

Nearly all Medicare Part D enrollees who received buprenorphine for the treatment of opioid use disorder received the recommended dose. Most enrollees received the buprenorphine and naloxone combination product. This reduces the risk of misuse or diversion. However, 16% of her enrollees received the buprenorphine stand-alone product. A small number of enrollees received either very high doses of buprenorphine or received buprenorphine concurrently with high doses of opioids indicated for pain.

Most prescribers ordered buprenorphine for only a limited number of enrollees, which may provide opportunities for increased access. Furthermore, few prescribers had patterns that raised concern. His 35 prescribers were the only prescribers to order buprenorphine for multiple Part D enrollees who received very high levels of buprenorphine or who received buprenorphine concurrently with large doses of opioids.

What OIG recommends

Taken together, these findings suggest a low risk of misuse and diversion of buprenorphine in Medicare Part D. These findings further support the recent repeal of the DATA exemption, which was implemented in part to limit the diversion of buprenorphine. Removing exemptions is an important step towards increasing access to treatment.

In addition, the data in this report will provide baseline information on buprenorphine use and prescribing, and help CMS, the Department, and other agencies implement changes related to obsolescence and improve access to buprenorphine. Ensure the risk of buprenorphine while helping you take other measures for Abuse and diversion are still low.

Therefore, we recommend that CMS (1) monitor buprenorphine use and share information with departmental partners as appropriate. (2) inform health care providers about the low risk of buprenorphine use and diversion to encourage them to treat more Part D registrants with opioid use disorders; (3) Take steps to inform providers of the availability of Part D buprenorphine-containing products to minimize the risk of misuse or diversion. (4) follow up prescribers on patterns of concern identified in this report; CMS agreed with her three recommendations of our company. It did not indicate whether it agreed with the other recommendations, but indicated continued activity that it appeared to respond to.