A U.S. government watchdog found that Medicare drug plans improperly authorized thousands of prescriptions for certain powerful opioids over a recent four-year period, a failure that cost taxpayers $86 million as the opioid crisis was raging across the country.
Between July 2015 and December 2019, Medicare Part D plans covered more than 7,500 prescriptions for so-called TIRF opioid painkillers, which contain fentanyl and are administered through the nose or mouth. The opioids were approved by U.S. regulators for managing breakthrough cancer pain, which is a sudden increase in pain beyond the usual chronic suffering felt by cancer patients.
Yet 810 Medicare beneficiaries received these opioids even though they lacked a cancer diagnosis. And this happened because the Part D plans did not have adequate systems — known as prior authorization — to review and approve prescriptions before they were dispensed, according to a report issued by the Office of Inspector General of the Department of Health and Human Services.
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