Opioid epidemic costs shifting to insurers

Dive Brief:

  • Private and public health insurers are now paying a far higher share of the cost for opioid misuse and addiction than patients, according to research from the Centers for Disease Control and Prevention.
  • The research, published in Health Affairs, used data from the Medical Expenditure Panel Survey to analyze trends in opioid pain reliever costs, coverage by a variety of insurers, and use from 1999 to 2012.
  • It found consumer out-of-pocket spending on opioids per 100 morphine milligram equivalents dropped from $4.40 to $0.90 between 2001 and 2012.

​Dive Insight:

The findings, which dovetail with other major efforts this year to address opioid abuse, highlight the value in payers taking a role in curbing opioid abuse, and evaluating their strategies around opioids to reduce potentially avoidable deaths, the researchers suggest.

They point specifically to Medicare, noting that since the implementation of Medicare Part D in 2006, it has been the largest payer for opioid dugs, and spends more on them for enrollees under age 36 than for any other age group, and more than Medicaid or private insurance spends on them for any age group. "Further research is needed to evaluate whether payer strategies to address the overuse of opioids could reduce avoidable opioid-related mortality," the report concludes.

As noted by FierceHealthPayer, much of the change may be attributed to changes in prescription benefits for dual eligibles following Medicare Part D. "Given that Medicare spending for opioids among patients younger than age sixty-five has exceeded Medicaid spending for opioids since 2006," it quotes the report, "disabled Medicaid enrollees receiving their prescription benefits through Medicare Part D likely represent a large percentage of Medicaid recipients who are prescribed opioids."

Filed Under: Payer
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