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.”
