Assesses potentially high-risk opioid analgesic prescribing practices: The proportion of members 18 years and older, receiving prescription opioids for ≥15 days during the measurement year from multiple providers. Three rates are reported.
- Multiple Prescribers: The proportion of members receiving prescriptions for opioids from four or more different prescribers during the measurement year.
- Multiple Pharmacies: The proportion of members receiving prescriptions for opioids from four or more different pharmacies during the measurement year.
- Multiple Prescribers and Multiple Pharmacies: The proportion of members receiving prescriptions for opioids from four or more different prescribers and four or more different pharmacies during the measurement year (i.e., the proportion of members who are numerator compliant for both the Multiple Prescribers and Multiple Pharmacies rates).
Note: A lower rate indicates better performance for all three rates.
Why It Matters
In 2016, opioid-related overdoses accounted for more than 42,000 deaths in the United States.1 Of those, 40% involved prescription opioids.1 One area of risk related to opioid use is receipt of opioid prescriptions from multiple prescribers and pharmacies. Studies show that individuals who receive opioids from four or more prescribers or pharmacies have a higher likelihood of opioid-related overdose death than those who receive opioids from one prescriber or one physician.2 Evidence suggests that people who see multiple prescribers and use multiple pharmacies are at higher risk of overdose.3
This measure provides health plans with a tool to identify members who may be at high risk for opioid overuse and misuse.
Results – National Averages
Use of Opioids from Multiple Providers - Multiple Prescribers
| Measure Year | Commercial HMO | Commercial PPO | Medicaid HMO | Medicare HMO | Medicare PPO |
|---|---|---|---|---|---|
| 2022 | 14 | 13.5 | 19.3 | 14.1 | 12.6 |
| 2021 | 14.2 | 13.6 | 19.4 | 13.2 | 12.2 |
| 2020 | 13.5 | 13.4 | 18.8 | 12.5 | 11.6 |
| 2019 | 15.2 | 14.6 | 20.7 | § | § |
| 2018 | 15.1 | 15.9 | 23.2 | 15.6 | 12.6 |
Use of Opioids from Multiple Providers - Multiple Pharmacies
| Measure Year | Commercial HMO | Commercial PPO | Medicaid HMO | Medicare HMO | Medicare PPO |
|---|---|---|---|---|---|
| 2022 | 2 | 1.7 | 3.1 | 1.7 | 1.2 |
| 2021 | 2.2 | 2.1 | 3.5 | 1.4 | 1.1 |
| 2020 | 2.1 | 2.1 | 4.5 | 2.0 | 1.4 |
| 2019 | 3.6 | 3.2 | 6.3 | § | § |
| 2018 | 5.1 | 5.2 | 8.3 | 4.5 | 3.3 |
Use of Opioids from Multiple Providers - Multiple Prescribers and Multiple Pharmacies
| Measure Year | Commercial HMO | Commercial PPO | Medicaid HMO | Medicare HMO | Medicare PPO |
|---|---|---|---|---|---|
| 2022 | 0.8 | 1 | 1.9 | 0.9 | 0.6 |
| 2021 | 1 | 1.1 | 2.1 | 0.7 | 0.5 |
| 2020 | 0.9 | 1.0 | 2.4 | 0.8 | 0.6 |
| 2019 | 1.5 | 1.5 | 3.2 | § | § |
| 2018 | 1.9 | 2.5 | 4.8 | 2.3 | 1.2 |
§ Not available due to CMS suspension of data reporting during COVID-19 pandemic.
This State of Healthcare Quality Report classifies health plans differently than NCQA’s Quality Compass. HMO corresponds to All LOBs (excluding PPO and EPO) within Quality Compass. PPO corresponds to PPO and EPO within Quality Compass.
Figures do not account for changes in the underlying measure that could break trending. Contact Information Products via my.ncqa.org for analysis that accounts for trend breaks.
References
- S. Department of Health and Human Services (HHS). 2019. “What is the U.S. Opioid Epidemic?”. Updated September 4, 2019. Retrieved from: https://www.hhs.gov/opioids/about-the-epidemic/index.html
- Gwira Baumblatt, J.A., C. Wiedeman, J.R. Dunn, W. Schaffner, L.J. Paulozzi, T.F. Jones. 2014. High-Risk Use by Patients Prescribed Opioids for Pain and Its Role in Overdose Deaths. JAMA Intern Med 174(5):796–801.
- Katz, N., L. Panas, M. Kim, A.D. Audet, A. Bilansky, J. Eadie, P. Kreiner, F.C. Paillard, C. Thomas, and G. Carrow. 2010. “Usefulness of Prescription Monitoring Programs for Surveillance—Analysis of Schedule II Opioid Prescription Data in Massachusetts, 1996–2006. Pharmacoepidemiology and Drug Safety 19:115–23.