OBJECTIVES: To determine rates of opioid prescribing in Medicare Part D by US state and region, overall, and by generalist prescribers

METHODS: We conducted a cross-sectional analysis of the Medicare Part D Prescribers by Provider and Drug Dataset for 2020, which is comprised of provider-level summaries of pharmacy dispensings issued to de-identified Medicare Part D enrollees of Medicare Advantage and Stand-alone Part D Prescription drug plans. The total annual opioid claim counts and percentage of opioid dispensing issued by provider type (generalist/specialty) in each state, each US census region, and the US were calculated, for all prescription opioids of any type. We divided the number of annual opioid prescriptions issued for each US state by the number of enrolled beneficiaries in that state in 2020 to obtain the total annual number of opioid dispensings per enrollee.

RESULTS: Medicare Part D prescription opioid claims per enrollee ranged from 0.567 to 2.13 across US states during 2020. Alabama led among 50 US states with the highest annual rates (2.129 per enrollee) of Part D prescription opioid claims, whereas Hawaii had the lowest rate (0.566 per enrollee). Higher rates of prescription opioid claims per enrollee were observed for the US South among the 4 US census regions. Vermont had the highest (76%) and Florida had the lowest (38%) percentage of opioids issued by generalist providers, while the proportion of opioids issued by generalists was highest in Vermont, Iowa, Maine, Mississippi, and Tennessee.

CONCLUSIONS: This national analysis of opioid dispensings for Medicare Part D beneficiaries in 2020 revealed significant inter-state variation in per-enrollee dispensing rates, overall by generalist prescribers. These results suggest the need for continued investigation into regional and provider-specific factors influencing opioid prescribing practices.