One Size Opioid Dose Does Not Fit All

From comment section:

November 14, 2014 at 8:11 PM

Potential Policy Fixes to Curb Medicare Part D Opioid Abuse

Published on: October 22, 2014
Annually, about 11.5 million beneficiaries fill a prescription for an opioid. Removing the 1.5 million beneficiaries who have cancer diagnoses or use hospice, analysis of the remaining 10 million person data set is striking.

Okay, just look at this figure of 10 million people with non-cancer pain — that’s how many people will be affected by this war against pain patients.  But to make a comparison to the NIH’s estimate of about 100 million Americans suffering from chronic pain, that means only about 10% of people with chronic pain are currently being treated with opioid therapy, which is not too bad. Further though, that means about 88.5 million people are suffering from chronic pain and are NOT being treated — at least, through legal and accountable ways.

[Edit:  Okay, I forgot, we’re just looking at the beneficiaries at Express Scripts, so I can’t compare that patient population to the whole of the U.S.]

The top 5% of opioid users account for 69% ($1.9 billion) of total spending on opioids. Users in this percentile, on average, fill twenty-three opioid prescriptions per year at a direct cost of $3,716 per person.  29% receive prescriptions from four or more prescribers, and 31% fill prescriptions at three or more pharmacies.

Under authority granted by Section 6405 of the Affordable Care Act, the Center for Medicare and Medicare Services (CMS) has enacted changes that will go into effect on June 1, 2015. Physicians prescribing opioids to Part D beneficiaries will now have to be enrolled in Medicare, prescriptions ordered by unauthorized physicians will be denied, and Medicare enrollment will be revoked for abusive prescribing.  CMS is also working to develop a tool that will monitor abuse by both prescribers and pharmacies.

The pain doctor I saw for about 8 years initially took Medicare, but only for a few years — then he opted out, and I had to pay for this cost without reimbursement from Medicare.  It ended up being about $250 a month.  So, I’m thinking that this new change by CMS is a really big thing…

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