OBJECTIVES : Over the past two decades, Opioid misuse and abuse has become a public health epidemic in the United States. Since the implementation of Medicare Part D in 2006 to cover prescription medications, the Medicare program has become the largest payer for prescription opioids in the U.S. Safe and effective opioid prescribing for older adults is of particular importance because misuse and abuse of opioids could lead to increased adverse events in this population. The objective of this study was to examine the utilization and spending of opioid medications among Medicare Part D beneficiaries.

METHODS : We analyzed data from the Centers for Medicare and Medicaid Services (CMS) for a nationally representative sample of 5% Medicare beneficiaries, who were continuously enrolled in fee-for-service (FFS) Parts A, Part B, and a stand-alone Part D plan in 2016. Beneficiaries with Medicare Part C were excluded because their complete medical claims are not available for them. We assessed prevalence of opioid medication use, total drug spending and out of pocket spending on opioids. All opioid prescriptions were standardized to a 30-day supply. Beneficiaries’ demographic and health status were adjusted.

RESULTS : In 2016, approximately one third of Medicare beneficiaries with Part D enrollment received at least one opioid prescription. Total drug spending per opioid prescription varies substantially (5^th-95^th percentiles: $4-$103). There was also wide variation in out-of-pocket spending per opioid prescription (5^th-95^th percentiles: $2-$58).

CONCLUSIONS : Despite federal government agencies have taken various initiatives to improve opioid prescribing practices given the ongoing national public health crisis of opioid misuse, our findings suggest potential opioids overutilization among Medicare populations and wide variation in drug spending on opioid medications. Policy makers may further consider assessing health system factors that may influence use of opioid medications in order to promote high quality of opioid prescribing.