President Trump recently declared the opioid crisis a national emergency, signaling a new era in the fight against this deadly epidemic. The increased attention and commitment can’t come fast enough: There were 2 million people addicted to prescription painkillers in 2016 and over 20,000 deaths from overdose, representing an overdose rate that has tripled since 2000. While the effects of the epidemic are disturbing in their breadth, it is particularly concerning to see the disproportionate effect that the epidemic has had on one particularly vulnerable population: Medicaid beneficiaries.
A major factor influencing addiction within the Medicaid population is the sheer number of opioid prescriptions being written – 15 percent of Medicaid enrollees had at least one prescription opioid claim during 2012. Controlling prescribing can limit excessive opioid usage and encourage other methods of pain management. In this post we explore the cost and toll of the epidemic, as well as the different approaches that state Medicaid programs are using to monitor prescribing and next steps for Medicaid programs looking to address overprescribing.
Impact on Medicaid population
The cost of the opioid epidemic to Medicaid is large and growing. A 2016 CDC study estimates that opioid addiction cost Medicaid $5.5 billion between 2011 and 2012, including inpatient, outpatient, and prescription costs for individuals with clinically diagnosed addiction.
Meanwhile, spending on the drugs themselves came to $500 million for over 34 million prescriptions in the same year, representing 2 percent of all net prescription drug expenditures – and that’s just for fee-for-service Medicaid. With state budget cuts looming and a disproportionate share of Medicaid enrollees affected by the epidemic, state Medicaid programs need to find ways to prevent addiction and reduce associated costs. And the first step toward reducing addiction is to reduce the number of opioid prescriptions written in the first place.
How states are addressing overprescribing
Many states are taking steps to track and control prescribing behavior around opioids. The below infographic describes some of the tactics and their prevalence across the country.