Toomey calls for Medicare, Medicaid to expand monitoring of opioid prescriptions

Pennsylvania U.S. Sen. Pat Toomey (far right) attended a hearing on opioid prescriptions in Bensalem Tuesday.(Kimberly Paynter/WHYY)

Pennsylvania U.S. Sen. Pat Toomey (far right) attended a hearing on opioid prescriptions in Bensalem Tuesday.(Kimberly Paynter/WHYY)

Pennsylvania U.S. Sen. Pat Toomey called for greater oversight of opioid prescriptions to patients on Medicare and Medicaid at a hearing in Bucks County Tuesday.

Medicare is the single largest buyer of prescription opioids in the country. One out of three people enrolled in Medicare’s prescription drug benefit plan received one of the pills in 2016, according to the U.S. Department of Health and Human Services. Toomey said many of them are receiving prescriptions that go against best practices.

“There are still many, many people getting very large quantities of prescription opioids through federal government programs, and their consumption of these opioids is not being properly monitored,” Toomey said.

Many of those patients are on high doses that put them at risk for addiction, Toomey said, but Medicare doesn’t currently have a way to make sure they’re not being prescribed too many pills.

The Centers for Disease Control and Prevention issued guidelines in 2016 recommending that doctors prescribe no more than the equivalent of 90 milligrams of morphine per day to treat chronic pain. That same year, 1.6 million Medicare beneficiaries were receiving such prescriptions, which the CDC says can put patients at risk of addiction and overdose, Toomey said.

New policies going into effect next year will add more of these patients to a monitoring program instituted by the Centers for Medicare and Medicaid Services. But Toomey said just 44,000 patients will fall under its watch — “less than 3 percent of the people that the Centers for Disease Control believes are at risk based on the quantities that they are receiving,” he said.

A government official who testified at the hearing said that was because the criteria for monitoring focused not on the dose of the prescription, but on people who may be filling scripts from several doctors or pharmacies and potentially doctor-shopping.

“We made a recommendation in our 2017 report that [the Centers for Medicare and Medicaid Services] need to decouple that and to be able to track what you’re asking them to track,” said Mary Denigan-Macauley, acting director for health care at the U.S. Government Accountability Office.

Toomey also listened to testimony at the Bensalem hearing from law enforcement and a commercial health insurance executive on how to reduce excessive or improper prescribing. The senator is sponsoring bipartisan legislation to address the issue.

Want a digest of WHYY’s programs, events & stories? Sign up for our weekly newsletter.

It will take 126,000 members this year for great news and programs to thrive. Help us get to 100% of the goal.