Senators Pat Toomey (R-Pennsylvania) and Tim Kaine (D-Virginia) commissioned a study regarding the Centers for Medicare and Medicaid Services (CMS). The study focused on determining how to improve the agency’s process of overprescribing of opioid drugs.

The Government Accountability Office (GAO) conducted the study. Senators Toomey and Kain believe that the overprescribing of opioid drugs to Medicare beneficiaries contributes to the national epidemic.

According to the senators, the GAO study showed that over 700,000 Medicare beneficiaries received high doses of opioids last year. These senior citizens are at risk of opioids addiction due to significant operational gaps within the federal health insurance program.

Highlights of the GAO report on CMS Opioid Misuse Strategy

In the report, GAO noted that CMS started to collect information on some beneficiaries using higher doses of opioids. The federal health insurance program’s Opioid Misuse Strategy includes reducing the risk of harm from opioid abuse. However, its approach misses some of them who could be at risk of harm, according

Additionally, GAO said, “CMS is limited in its ability to assess progress toward meeting the broader goals of its Opioid Misuse Strategy.” It is overseeing the prescribing of drugs at rick of abuse through different project. However, it is not analyzing data particularly on opioids.

According to GAO, CMS and plan sponsors identify providers who prescribe large amounts of drugs with a high risk of abuse. They refer to law enforcement those providers suspected of abuse or fraud.

Furthermore, GAO noted CMS does not identify providers who may be prescribing large amounts of opioids separately from other drugs. It does not require plan sponsors to report actions they take when they detect such providers.

“As a result, CMS is lacking information that it could use to assess how opioid prescribing patterns are changing over time, and whether its efforts to reduce harm are effective,” said GAO.  The agency based its conclusion on the guidelines of the Centers for Disease Control and Prevention (CDC).

GAO recommendations

Following the results of the study, GAO recommended the following executive action

• The CMS administrator should gather information over time on the number of beneficiaries at risk of harm from opioids. It should include those who receive high opioid morphine equivalent doses regardless of the number of pharmacies or providers.
• Secondly, the CMS administrator should require the National Benefit Integrity Medicare Drug Integrity Contractor to identify and conduct analyses on providers who prescribe high amounts of opioids separately. The contractor must separate its scrutiny on opioids providers from those prescribing high amounts of any Schedule II drug.
• Finally, the CMS administrator should require plan sponsors to report to their investigations and other actions taken related to providers who prescribe high amounts of opioids

In a statement, Sen. Toomey said, "This report is a stark reminder that much more still needs to be done to prevent overutilization, diversion, and abuse of prescription opioids in the Medicare program.”

In addition, he emphasized that the CMS must adopt the GAO recommendations urgently.

On the other hand, Sen. Kaine said the findings of the report are troubling. They need to improve CMS to protect seniors from the dangers of opioid overuse.