OIG Develops Two Toolkits to Calculate Opioid Levels and Identify At-Risk Patients

In a continued effort to combat the nation’s opioid crisis, the Department of Health and Human Services Office of the Inspector General (OIG) has recently developed two toolkits that analyze prescription data to identify patients at risk of opioid misuse or overdose. The toolkits are available in three programming languages – one toolkit includes SAS programming code and the other includes R and SQL programming code. OIG believes the toolkits will aid its public and private sector partners (e.g., Medicare Part D plan sponsors, private health plans, and State Medicaid Fraud Control Units) in combating the nation’s opioid crisis.

Overview of the Toolkits

Both toolkits provide steps to calculate a patient’s average daily morphine equivalent dose (MED). The MED converts various prescription opioids and strengths into a single standard value for healthcare providers to reference. Healthcare providers can then use the patient’s average MED to determine the patient’s risk for opioid misuse or overdose. The toolkits include the following chapters:

  • Analysis of Prescription Drug Claims Data;
  • Explanation of the Programming Code to Conduct the Analysis; and
  • Programming Code (In SAS, R or SQL programming languages, based on the toolkit utilized).

The analysis chapter details steps to collecting and analyzing the relevant information. First, users must collect the following data: (1) unique patient identifier; (2) prescription fill date; (3) quantity dispensed, or the number of units dispensed; (4) total days’ supply; and (5) national drug code (NDC). Users may also include additional fields (e.g., unique prescriber identifier and unique pharmacy identifier) to determine patterns of concern in opioid prescribing.

Once the data is collected, the users merge it with the Centers for Disease Control and Management’s morphine milligram equivalent (MME) conversion data. The merger requires two fields: (1) MME conversion factor and (2) strength per unit. This will permit the user to determine the patient’s MED. Once the MED is determined, the user will review the patient’s medical history and applicable medical data to determine the patient’s level of risk of misuse or overdose. In addition to analyzing prescription claims data to identify at-risk patients, the OIG believes the toolkits will assist in answering research questions about opioid utilization.

The toolkits also include a chapter with the programming code for each toolkit in a specific programming language (SAS, R or SQL). Users are permitted to modify the code to meet their specific needs (e.g., identifying patients at varying risk levels). A more detailed description of the toolkit utilizing the SAS programming language may be found here. A more detailed description of the toolkit utilizing the R or SQL programming languages may be found here.

OIG Brief Issued Alongside Toolkits

OIG has conducted extensive research and developed extensive work regarding opioid use by Medicare Part D beneficiaries. Alongside these toolkits, OIG has issued a data brief, detailing its findings and concerns of opioid misuse in Medicare Part D. The OIG’s brief includes the following findings: nearly 49,000 Part D beneficiaries at serious risk of opioid misuse or overdose; nearly 354,000 beneficiaries received high amounts of opioids; and the number of beneficiaries receiving medication-assisted treatment for opioid use disorder increased to 174,000 in 2018. This research clearly showcases the need for action to curb opioid misuse. Again, OIG intends for these toolkits to be utilized to combat the opioid crisis plaguing the nation by identifying at-risk patients for potential intervention.

The Toolkits and COVID-19

Lastly, note that these toolkits may be very useful during the COVID-19 pandemic, as the National Institutes of Health has issued a warning that individuals that user opioids are at greater risk from COVID-19. Specifically, opioid users are at greater risk because COVID-19 attacks the lungs and respiratory disease is known to increase mortality risk for those using opioids. Therefore, the toolkits could help providers, health plans, and others identify patients at greater risk to COVID-19 and address that risk during the pandemic.

For any questions regarding the OIG’s toolkits or the defense of pharmacy related federal or state audits or investigations, please contact Robert Iwrey, Esq. at riwrey@thehlp.com, or your regular HLP attorney, or Partners@thehlp.com, or call (248) 996-8510.

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