7 findings on Medicaid opioid use and spending

Amy Bernstein, policy director at the Medicaid and CHIP Payment and Access Commission, and Nevena Minor, a senior analyst at MACPAC, penned a Health Affairs blog post examining prescription opioid use by Medicaid beneficiaries and Medicaid prescription opioid spending.

For their analysis, the blog authors used MACPAC Medicaid claims data from 2010 to 2012.

Here are seven key findings cited in the blog post.

1. Medicaid paid more than $500 million for more than 34 million claims for opioid drugs in 2012, according to MACPAC. The blog authors said this excludes spending by managed care organizations on behalf of their members.

2. MACPAC also found the total number of opioid claims in fee-for-service and managed care arrangements dropped from 35.7 million in 2010 to 34.3 million in 2012.

3. Opioid prescriptions as a share of all prescription drug claims dropped from 6.5 percent in 2010 to 6.1 percent in 2012.

4. In 2012, 15 percent of Medicaid enrollees had at least one opioid prescription.

5. According to MACPAC, 35 percent of disabled Medicaid enrollees had at least one opioid prescription in 2012. That compares to 13 percent of nondisabled enrollees.

6. The blog authors found varying opioid use rates across states. According to MACPAC, the percentage of Medicaid enrollees with at least one opioid prescription ranged from less than 10 percent to almost a quarter of enrollees across states.

7. The blog authors also analyzed Medicaid prescription opioid supply. They found 48 percent of Medicaid opioid prescriptions in 2012 were for short-term use with a day supply of two weeks or less, while about one-third were for a month's supply.

In response to prescription opioid use and spending patterns, state Medicaid programs are implementing various policies, such as prior authorization requirements and quantity limits on opioid dispensing, among others, according to the authors.

"States are tailoring their efforts to expand substance use disorder benefits and the number of enrollees eligible for this care through various mechanisms, including through Section 1115 waivers, the rehab option and the health homes option," the blog authors conclude. "In doing so, individual states face often difficult questions, such as how to best allocate limited state funds, or how to expand treatment capacity when there is an insufficient number of treatment providers. As policymakers contemplate additional ways to stem the continuing epidemic, it is important to recognize that Medicaid programs remain on the front lines — and to consider how to most effectively support individual state responses."


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