A retrospective analysis of targeted letters to outlier prescribers of opioids and benzodiazepines

What was the challenge?

Opioid overprescribing represents a significant public health issue. Under the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities (SUPPORT) Act, the Centers for Medicare & Medicaid Services’ (CMS) sends annual notifications to outlier prescribers to encourage appropriate prescribing of opioids.

What was the program change?

CMS’s Center for Program Integrity (CPI) designed and implemented annual peer-comparison interventions, which targeted outlier prescribers of opioids and outlier co-prescribers of concomitant opioids and benzodiazepines. In January 2020, letters were sent to 689 prescribers who were in the top 10 percent, compared to their peers in the same state, for both the percent of Medicare beneficiaries with overlapping opioid and benzodiazepine prescriptions and the average Morphine Milligram Equivalent (MME) per day of opioids prescribed to those beneficiaries.

Letters were designed to overcome (i) lack of information on the part of the prescribers regarding appropriate prescription levels and/or (ii) a lack of attention to their opioid prescribing behavior.

How did the evaluation work?

OES recommends analyzing Medicare Part D Prescription Drug Event (PDE) data using the CMS Integrated Data Repository (IDR) which tracks Medicare beneficiary enrollment healthcare utilization. This would involve comparing prescriber behavior among those who received the letters to prescribers in the 80th-89th percentiles who did not receive a letter.

We recommend prescriber behavior be measured in terms of the following outcomes of interest:

  1. Total MME among patients co-prescribed opioids and benzodiazepines, and
  2. Percent of beneficiaries with overlapping prescriptions.

What was the impact?

OES was not able to complete the analysis as planned. In cases where data are not available or the evaluation did not provide comparable comparison groups, OES does not report results. In this case, outcome data were not available in the format needed for analysis.

The analysis plan posted on the OES website details a strategy for how a potential analysis may be conducted. CMS plans to complete the analysis and report their findings.

To verify the upload date of our Analysis Plan, click here.





Project Type

Program Change and Evaluation


Health and Human Services




View Analysis Plan (PDF)

View Abstract (PDF)

View Intervention Pack (PDF)