Analysis Reveals Short-Term Gains and Ongoing Issues with 2019 Medicare Opioid Policy

A recent analysis conducted by the Harvard Pilgrim Health Care Institute has highlighted the early effectiveness and subsequent challenges of a Medicare opioid safety policy implemented in 2019. The study, featured in JAMA Internal Medicine, indicates that while the policy initially succeeded in reducing opioid prescriptions among high-risk populations, its impact has waned over time.

The Medicare program provides coverage for approximately 9 million adults under the age of 65 with disabilities. This demographic, despite making up only 3% of the U.S. population, is responsible for 25% of opioid-related overdose deaths and hospitalizations. In response to this crisis, the Centers for Medicare & Medicaid Services (CMS) mandated that all Medicare Part D plans enforce an opioid safety policy beginning January 1, 2019. This policy includes restrictions on new opioid prescriptions, limiting initial fills to a maximum of a 7-day supply, and capping daily prescriptions at 90 morphine milligram equivalents (MME).

Researchers from Harvard Pilgrim Health Care Institute, alongside their collaborators, evaluated the policy's effects on both new and long-term opioid users among Medicare beneficiaries with disabilities. They aimed to determine whether the policy led to shorter initial prescriptions and a decrease in the progression to long-term opioid use, while also preventing the disruption of stable high-dose therapy or adverse health events.

The study utilized data from Optum's deidentified Clinformatics Data Mart database, analyzing a cohort of beneficiaries over a period that included 31 months before the policy's enactment and 33 months following its implementation. The research focused on two primary groups: new users, defined as individuals who filled their first opioid prescription after a three-month period without opioids, and long-term users, characterized as those who had been on opioids for 60 days or longer, with a cumulative supply exceeding 80 days within a four-month window.

Results from the analysis suggest that the 2019 opioid safety policy successfully curtailed the duration of initial opioid prescriptions and reduced the frequency of high-dosage prescriptions prescribed by multiple providers among long-term users. Specifically, the 7-day prescription limit produced immediate and sustained reductions in prescriptions exceeding this duration. However, the effectiveness of these measures appeared to decline towards the end of the study period. The limit on daily MME also initially led to a decrease in high-dosage prescriptions issued by multiple prescribers, although this improvement reversed following the rollback of COVID-19-related flexibilities that had previously supported the 90-MME cap.

According to the researchers, these findings underscore the necessity for ongoing efforts to address the opioid crisis through policies that are adaptable, evidence-based, and sensitive to the unique needs of vulnerable populations. The analysis stresses the importance of understanding the longer-term effects of such policies and identifying at-risk subgroups that may require targeted interventions.

The study's lead researcher emphasizes the critical nature of evaluating opioid prescribing policies as part of a broader strategy to mitigate the opioid crisis's impact on high-risk groups, particularly disabled Medicare beneficiaries. Policymakers and insurers are encouraged to consider further interventions that address the medical and social factors contributing to opioid misuse.