Medicare Opioid Policy and Opioid Use in Beneficiaries With Disabilities

Medicare beneficiaries with disabilities have excess opioid-related morbidity and mortality. A 2019 Medicare opioid safety policy was designed to address high-risk opioid prescribing and related harms by limiting the initial duration to 7 days and restricting high daily dosage across multiple prescribers.

To evaluate the association of the 2019 Medicare opioid 7-day and 90-morphine milligram equivalence (MME) safety edits with opioid use among beneficiaries with disabilities.

This interrupted time-series study used claims data from Optum's deidentified Clinformatics Data Mart database to assess changes in opioid prescriptions and use among Medicare Advantage beneficiaries (younger than 65 years) with disability entitlements from June 2016 to September 2021. The analysis compared opioid use outcomes before and after the safety policy was implemented in 2019 (including the COVID-19 pandemic) in 2 cohorts of patients (new to opioids vs long-term opioid use). Data analyses were performed from September 2023 to October 2024.

Implementation of the Medicare opioid 7-day and 90-MME safety edits in January 2019.

Likelihood of an initial opioid prescription more than 7 days' supply and 30-day total MME; likelihood of development of long-term opioid use in a new-to-opioid cohort; the number of concurrent multiple-prescriber high-dosage episodes in a long-term opioid cohort.

The new-to-opioids cohort included 476 859 person-index months (mean [SD] age, 55.7 [7.8] years; 281 536 [59.0%] women). The long-term opioid cohort included 3 295 299 person-index months (mean [SD] age, 56.3 years [6.6]; 1 887 547 [57.3%] men and 1 407 752 [42.7%] women). The 7-day safety edit was associated with immediate and sustained reductions in the likelihood of an initial opioid prescription filled for more than 7 days' supply (start of the post-policy period: 46.7 % reduction; 99.5% CI, -48.3% to -45.2%; end of study period: 43.8% reduction; 99.5% CI, -45.7% to -41.9%). In contrast, moderate immediate reductions in the likelihood of development into long-term opioid use (13.8% reduction; 99.5% CI, -20.5% to -7.2%) diminished by the end of the study period (4.0% reduction; 99.5% CI, -10.4% to 2.4%). The 90-MME safety edit was associated with an immediate 36.1% reduction (99.5% CI, -42.8% to -29.4%) in the number of concurrent multiple-prescriber high-dosage episodes, which was reversed when the COVID-19 flexibility rolled back the 90-MME edit.

The findings of this interrupted time-series study of Medicare Advantage beneficiaries younger than 65 years with disabilities show that the 2019 Medicare opioid safety policy was associated with shorter initial duration of opioid prescriptions and fewer concurrent multiple prescriber high-dosage prescriptions of opioids. Given that downstream reductions appeared to be transient, further interventions are needed to address the clinical and social risk factors for opioid misuse among beneficiaries with disabilities.