OBJECTIVES: Medicare is a US federal health insurance program, available for people age 65+, younger people with disabilities and people with End Stage Renal Disease. This research aims to compare opioid utilization and cost among elderly and nonelderly Medicare beneficiaries by state.

METHODS: This retrospective observational study used data from the de-identified 2015 Medicare Provider Utilization and Payment Data Public Use File, which includes prescription drug utilization and cost for 46 million elderly and 9 million non-elderly Medicare beneficiaries. Opioids were categorized based on Medicare’s Part D Overutilization and Monitoring System. By state, number of standardized 30-day prescriptions for opioids was divided by the total to arrive at percent of 30-day standardized prescriptions for opioids for elderly and non-elderly beneficiaries. The percent of costs spent on opioids was also calculated by state. Correlation coefficients were estimated to measure the strength of the association between opioid use and cost in the elderly and non-elderly.

RESULTS: Percent of opioid prescriptions to total in the nonelderly ranged from 10.8% in Nevada to 5.0% in New York, and for the elderly from 4.1% in Alaska to 1.7% in New York. Similarly, the percent of costs spent on opioids ranged from 10.8% in Alaska to 3.3% in Hawaii in the nonelderly, and 4.2% in Alaska to 1.2% in New York for the elderly. The correlation was 0.84 (p<.001) between elderly and nonelderly for the percent of opioid prescriptions and 0.82 (p<.001) for the percent of costs spent on opioids.

CONCLUSIONS: Opioid utilization was more than twice as high in nonelderly than in elderly Medicare beneficiaries. Future research is needed to determine whether there is overutilization in the nonelderly, particularly in states such as Nevada and Alaska, and to examine why states like New York have relatively limited use.