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Initial Opioid Prescribing for Long Duration (IOP-LD)

CBE ID
3558
Endorsement Status
1.0 New or Maintenance
1.1 Measure Structure
Previous Endorsement Cycle
Is Under Review
Yes
Next Maintenance Cycle
Spring 2025
1.6 Measure Description

The percentage of individuals ≥18 years of age with ≥1 initial opioid prescriptions for >7 cumulative days’ supply during the measurement year.

Measure Specs
General Information
1.7 Measure Type
1.3 Electronic Clinical Quality Measure (eCQM)
1.8 Level of Analysis
1.9 Care Setting
1.9b Other Care Setting
Health Plan
1.10 Measure Rationale

Opioid misuse, addiction, and overdose remain a public health crisis affecting social and economic welfare in the United States. Drug overdoses involving an opioid accounted for 79,358 deaths in 2023, resulting in an age-adjusted drug overdose death rate that has more than tripled since 2013 and increased five-fold since 2003.(1) While synthetic opioids such as fentanyl are a substantial driver of increased mortality, the prescription opioid epidemic has not abated: nearly 8.6 million Americans reported misusing prescription opioids in 2023.(2) Prescription opioid safety remains an important priority, and quality measures serve as valuable tools to promote opioid safety and improve the quality of care for patients.

 

A large body of scientific evidence, described in detail in section 2.2 Evidence of Measure Importance, has established an association between greater duration of initial opioid exposure and significant risks, including increased likelihood for long-term opioid use, misuse, and overdose. To highlight, a retrospective cohort study by Shah et al. published in the CDC Morbidity and Mortality Weekly Report found that the probability of long-term opioid use increased with each additional day supplied past the third day when initiating opioid therapy; the probability of long-term use was more than twice as high for individuals who received greater than 7 days’ supply. 

 

Based on this evidence, regulatory bodies have issued recommendations and instituted policies regarding the duration of therapy for initial opioid prescribing. In its 2022 Clinical Practice Guideline for Prescribing Opioids for Pain, the Centers for Disease Control and Prevention (CDC) provided updated recommendations regarding duration of initial opioid prescriptions.(3) The recommendations state that “when opioids are needed for acute pain, clinicians should prescribe no greater quantity than needed for the expected duration of pain severe enough to require opioids.” This recommendation is category A (applies to all persons; most patients should receive the recommended course of action) and evidence type 4 (clinical experience and observations, observational studies with important limitations, or randomized clinical trials with several major limitations). 

 

Additionally, federal regulatory requirements and published guidance from the Centers for Medicare & Medicaid Services (CMS) note that Medicare plan sponsors are expected to implement real-time opioid safety edits at the point of sale, including an edit to limit initial opioid prescription fills for opioid naïve beneficiaries to no more than a 7 days’ supply.(4) An internal analysis of Part D data from 2018 to 2023 conducted by CMS  showed that the percentage of Part D claims for opioids (excluding medications used for opioid use disorder) with 7 days’ supply or less increased from 18.4% in 2018 to 27.7% in 2023 after the implementation of enhanced opioid safety edits at the point of sale in 2019.(5) This measure serves as a retrospective complement to these edits.

 

To help ensure consistent application of these clinical recommendations and efforts to ensure safe initial opioid prescribing, measurement serves as a critical tool. The PQA Initial Opioid Prescribing for Long Duration measure evaluates initial opioid prescriptions for greater than 7 days’ supply, which are associated with increased risk of long-term opioid use, misuse, and overdose. Use of this measure to evaluate the performance of health plans is intended to reduce these risks, in turn leading to reduced health care resource utilization and improved quality of life. Because the measure only captures initial opioid prescriptions in individuals with no opioid history in the preceding 90 days, and does not penalize subsequent prescriptions for ongoing pain, it is not anticipated to result in unintended consequences related to access, discontinuation, or abrupt tapering in patients currently undergoing long-term opioid therapy.

 

References

1. Garnett MF, Minino AM. Drug overdose deaths in the United States, 2003-2023. NCHS Data Breif, No. 522. National Center for Heath Statistics. Updated December 2024. Accessed April 18, 2025. https://www.cdc.gov/nchs/data/databriefs/db522.pdf

2. Substance Abuse and Mental Health Services Administration. Key substance use and mental health indicators in the United States: Results from the 2023 National Survey on Drug Use and Health. Vol. NSDUH Series H-59. 2024. Accessed April 18, 2025. https://www.samhsa.gov/data/report/2023-nsduh-annual-national-report

3. Dowell D, Ragan KR, Jones CM, Baldwin GT, Chou R. CDC Clinical Practice Guideline for Prescribing Opioids for Pain - United States, 2022. MMWR Recomm Rep. Nov 4 2022;71(3):1-95. doi:10.15585/mmwr.rr7103a1

4. Centers for Medicare & Medicaid Services. Contract Year (CY) 2025 Medicare Part D Opioid Safety Edits – Submission Instructions, Recommendations, and Reminders. 2024. Accessed April 18, 2025. https://www.cms.gov/files/document/cy-2025-opioid-safety-edit-submission-instructions.pdf

5. Centers for Medicare & Medicaid Services. Medicare and Medicaid Programs; Contract Year 2026 Policy and Technical Changes to the Medicare Advantage Program, Medicare Prescription Drug Benefit Program, Medicare Cost Plan Program, and Programs of All-Inclusive Care for the Elderly. 2024. p. 427.

1.20 Types of Data Sources
1.25 Data Source Details

This measure is calculated using standard data from medical claims, prescription claims, and health plan administrative enrollment data. These data fields are highly standardized across the healthcare industry and are a common data source for quality measures. The attached value sets include the full universe of codes required to calculate the measure.