Study Finds a Dramatic Shift in Payments for Opioids

A major shift in expenditures by payer type for opioid pain relievers occurred along with a 4-fold increase in overdose deaths from opioids in the United States.

A major shift in expenditures by payer type for opioid pain relievers occurred along with a 4-fold increase in overdose deaths from opioids in the United States, according to a study in Health Affairs. Private and public insurers paid a much larger share than patients, the study found.

Chao Zhou, PhD; Curtis Florence; and Deborah Dowell, MD, MPH, conducted this research to find the correlation between public and private insurance payments for opioids and a significant decline in consumer spending for the same.

For the research, the team used data from the Medical Expenditure Panel Survey (MEPS). The researchers examined trends in opioid pain reliever expenditures financed by various payers for the period from 1999 to 2012. The research included individuals with at least 1 opioid prescription.

In 1999, about 7% of the MEPS participants were prescribed opioids. By 2012 that share had increased to 10%. In 2012, there were 3534 MEPS participants with at least 1 opioid prescription, which on a nationally weighted average translates to approximately 36 million people. Breaking it down further into demographics, out of this population, 20% were ages 65 and older, and 40% were ages 45-64. The male to female ratio was 42 to 58. And 80% of the participants were white.

The sources of payment were defined as: self-pay, private insurance, other unclassified insurance, Medicare, Medicaid, and other federal/state/local/public insurance. The research pointed out that over time private and public insurers were paying a much larger share than patients. Consumer out-of-pocket spending on opioids per 100 morphine milligram equivalents declined from $4.40 to $0.90 between 2001 and 2012. In 2006, the Medicare Part D program was implemented. Since then, Medicare became the largest payer for opioid pain relievers, covering about 20% to 30% of the cost.

The Dramatic Shift Explained

Medicare spending for opioids among patients younger than age 65 dramatically exceeded Medicaid spending for opioids since 2006. According to the researchers, it safe to interpret this correlation as follows: Disabled Medicaid enrollees receiving their prescription benefits through Medicare Part D likely represent a large percentage of Medicaid recipients who are prescribed opioids.

“Medicaid recipients are at higher risk for overdose related to opioid pain relievers than the general population, and many of these patients may receive their prescription benefits through Medicare,” said Zhou, an economist at the CDC’s National Center for Injury Prevention and Control. “This study documents changes in the financing of opioid pain relievers that coincide with the opioid overdose epidemic.”

Majority of the opioid overdose deaths occur among adults ages 25-64. However, the overdose mortality is the fastest among people ages 55-64 than among any other age group. If all the different payers employ necessary strategies, they can influence a decrease in high-risk opioid utilization and ultimately reduce overdose mortality. Alongside, they can also ensure that patients with pain are treated in an appropriate fashion.