Medicaid's role in curbing the opioid epidemic

pills medicine pharmacy
In 2012, Medicaid paid more than $500 million for more than 34 million claims for opioid drugs.

As the country continues to combat the opioid epidemic, policymakers would be wise to look for insights from a healthcare program on the front lines—Medicaid.

That’s the position of Amy Bernstein and Nevena Minor, both of whom work for the Medicaid and CHIP Payment and Access Commission (MACPAC). In a new blog post for Health Affairs, they discussed how data on opioid use and expenditures can inform policies aimed at regulating and reducing prescription opioid use.

In 2012, 15% of Medicaid enrollees had at least one prescription opioid claim, according to MACPAC’s analysis of national Medicaid claims data. That varied considerably by region—ranging from less than 10% to almost a quarter of enrollees across different states. 

The cost to Medicaid was not insignificant: In 2012, the program paid more than $500 million for more than 34 million claims for opioid drugs. However, the total number of claims decreased slightly from 2011-2012, from 35.7 million to 34.3 million.

Another data point to note is that of the 6.9 million enrollees with opioid prescriptions in 2012, about 5% received prescriptions from five or more prescribers and about 2% filled them at five or more pharmacies. Both are potential indicators of opioid misuse.

For their part, Medicaid programs have implemented policies such as prescription drug monitoring programs, quantity limits on opioid dispensing, prior authorization requirements, preferred drug lists and patient review and restriction, the authors noted. However, MACPAC did not analyze whether such policies played a role in the slight reduction in the total number of opioid prescriptions between 2011 and 2012.

As such efforts continue, ongoing tracking of Medicaid claims data can help determine whether policies aimed at inappropriate prescribing are making a difference, Bernstein and Minor wrote. Policymakers must also consider how to most effectively support individual state responses, they added.

Private payers are also jumping on board in the effort to stem the opioid epidemic. Cigna, for instance, recently announced that it recorded a 12% decline in customers’ use of prescribed opioids in the last year, which it accomplished by leveraging its claims data to detect patterns of misuse and working with doctors.

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