Centers for Medicare and Medicaid Services (CMS) – Opioid Prescriptions

Description:

Centers for Medicare and Medicaid Services’ (CMS) opioid prescription claims include information about Medicare and Medicaid prescriptions.

CMS opioid claims and prescribing rates are available for all opioids as well as extended-release and long-acting (ER/LA) opioid formulations. Prescription numbers and rates for ER/LA opioids are also counted within the “all opioids” indicators. ER/LA opioids are designed to deliver more stable dosing for chronic pain patients and reduce dosage frequency but may pose a higher risk of overdose when misused. Certain methadone types are considered ER/LA. For a list of opioids included see https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/Medicare-Provider-Charge-Data/Downloads/OpioidDrugList.zip..

Medicare Opioid Prescriptions

CMS Medicare opioid prescription claims come from Medicare Part D claims prescribed by health care providers, as collected from Part D Prescriber public use files. Medicare opioid prescribing rates were calculated as the rate of opioid prescription claims per 100 total Medicare Part D prescription claims, including both prescriptions and refills. Medicare opioid prescription data includes claims for beneficiaries enrolled in Medicare Advantage Prescription Drug Plans and stand-alone Prescription Drug plans, but does not include prescriptions for patients on Medicaid, those with commercial insurance, or self-pay patients. Approximately 70% of Medicare beneficiaries have Medicare prescription drug coverage either from a Part D plan or a Medicare Advantage Plan offering Medicare prescription drug coverage. In 2017, Medicare Part D spending was $155 billion, while U.S. retail prescription drug spending was around $333 billion.

Due to data redactions for geographies with 10 or fewer claims, county and Zip code Medicare opioid claim totals may not add up to state totals or may be lower than the true program totals.

Medicaid Opioid Prescriptions

CMS Medicaid opioid prescription claims come from claims where a portion was paid through Medicaid, as reported through the Medicaid State Drug Utilization Data. Medicaid opioid prescribing rates were calculated as the rate of opioid prescription claims per 100 total prescription claims for which Medicaid paid a portion. CMS Medicaid opioid prescription data includes claims prescribed through Fee-For-Service (FFS) programs and Manage Care Organizations (MCO). In 2017, Medicaid spending on prescription drugs was $68 billion, while U.S. retail prescription drug spending was around $333 billion.

As of the 2025 data release, Medicaid opioid claims are available at the zip, county, and state level. However, data may be sparse for smaller geographies due to CMS data processing methods. County-and zip-level measures presented in this tool were aggregated from the Transformed Medicaid Statistical Information System (T-MSIS) Analytic Files (TAF).
In order to be included in this tool, state-level TAF data had to meet quality checks for each data year.
Due to known data quality issues in prior years, TAF data is presented only for data years 2016 and onward. In order to protect the privacy of beneficiaries, suppression is applied to the data. At each aggregated geographic level, any derived opioid claim counts between 1 and 10 are suppressed (replaced with missing a.k.a. Insufficient Data values).
Secondary suppression is applied in cases where a single subgroup category is primary suppressed.For example, if the Fee-for-Service opioid claim count for a given state is primary suppressed but the Managed Care opioid claim count is not primary suppressed, then the Managed Care opioid claim count for that state must be secondary suppressed to prevent disclosure of the Fee-for-Service opioid claim count suppressed value. Secondary suppression prevents backing into a primary suppressed value by using the values from the other opioid claim counts such as total opioid claim count. These claims include all types of opioids.