{
  "slug": "excluded-prescribing-medicare-partd",
  "title": "Federally excluded NPIs prescribing Medicare Part D (CY 2023, all states)",
  "hypotheses": [
    "H30",
    "H30b"
  ],
  "status": "published",
  "release_date": "CY 2023 (RY2025 P04)",
  "generated_at": "2026-05-17T15:34:08+00:00",
  "methodology_version": "0.6.1-draft",
  "commit_sha": "334099e",
  "headline": "416 of 6,840 currently-active federally-excluded NPIs (across 52 state cohorts) prescribed Medicare Part D in CY 2023 (full-window drug cost $119,792,842; 138 of 416 were opioid prescribers with 65,309 opioid claims). Of those, **6 were prescribing STRICTLY POST-EXCLUSION** (LEIE or SAM exclusion-effective year before 2023), with $8,662,186 drug cost and 2 opioid prescribers writing 137 opioid claims. The strict-post-exclusion subset is the regulatorily significant signal \u2014 pre-exclusion prescribing was authorized at the time.",
  "numerator": 6,
  "denominator": 6840,
  "numerator_full_window": 416,
  "numerator_note": "Numerator = NPIs prescribing Part D in CY 2023 with LEIE/SAM exclusion-effective year < 2023 (strict post-exclusion). Full-window numerator = 416.",
  "denominator_note": "Federally-excluded cohort across all 52 state slices (6,840 unique NPIs; active LEIE or SAM; score >= 1.5).",
  "data_source_release": "CY 2023 (RY2025 P04)",
  "data_source_url": "https://data.cms.gov/provider-summary-by-type-of-service/medicare-part-d-prescribers",
  "chart": {
    "type": "bar",
    "unit": "count",
    "data": [
      {
        "label": "All cohorts prescribing Part D (full-window)",
        "value": 416
      },
      {
        "label": "Strict post-exclusion",
        "value": 6
      },
      {
        "label": "Opioid prescribers (full-window)",
        "value": 138
      }
    ]
  },
  "per_state": [
    {
      "state": "CA",
      "matches_full_window": 74,
      "matches_strict_post": 1,
      "drug_cost_full_window": 19241829.17,
      "opioid_prescribers_full_window": 25
    },
    {
      "state": "TX",
      "matches_full_window": 32,
      "matches_strict_post": 1,
      "drug_cost_full_window": 21900926.31,
      "opioid_prescribers_full_window": 15
    },
    {
      "state": "FL",
      "matches_full_window": 28,
      "matches_strict_post": 0,
      "drug_cost_full_window": 2038823.18,
      "opioid_prescribers_full_window": 9
    },
    {
      "state": "PA",
      "matches_full_window": 22,
      "matches_strict_post": 1,
      "drug_cost_full_window": 5675400.43,
      "opioid_prescribers_full_window": 6
    },
    {
      "state": "NY",
      "matches_full_window": 20,
      "matches_strict_post": 0,
      "drug_cost_full_window": 13310069.83,
      "opioid_prescribers_full_window": 5
    },
    {
      "state": "OH",
      "matches_full_window": 16,
      "matches_strict_post": 0,
      "drug_cost_full_window": 1190681.66,
      "opioid_prescribers_full_window": 3
    },
    {
      "state": "TN",
      "matches_full_window": 16,
      "matches_strict_post": 0,
      "drug_cost_full_window": 4384692.25,
      "opioid_prescribers_full_window": 5
    },
    {
      "state": "MI",
      "matches_full_window": 14,
      "matches_strict_post": 0,
      "drug_cost_full_window": 3297029.02,
      "opioid_prescribers_full_window": 4
    },
    {
      "state": "IL",
      "matches_full_window": 13,
      "matches_strict_post": 0,
      "drug_cost_full_window": 3455202.88,
      "opioid_prescribers_full_window": 1
    },
    {
      "state": "NJ",
      "matches_full_window": 12,
      "matches_strict_post": 2,
      "drug_cost_full_window": 1280851.3,
      "opioid_prescribers_full_window": 6
    },
    {
      "state": "GA",
      "matches_full_window": 10,
      "matches_strict_post": 0,
      "drug_cost_full_window": 1871896.91,
      "opioid_prescribers_full_window": 5
    },
    {
      "state": "MO",
      "matches_full_window": 10,
      "matches_strict_post": 0,
      "drug_cost_full_window": 4199981.65,
      "opioid_prescribers_full_window": 4
    },
    {
      "state": "VA",
      "matches_full_window": 10,
      "matches_strict_post": 0,
      "drug_cost_full_window": 1363000.37,
      "opioid_prescribers_full_window": 7
    },
    {
      "state": "NC",
      "matches_full_window": 9,
      "matches_strict_post": 0,
      "drug_cost_full_window": 2015191.04,
      "opioid_prescribers_full_window": 4
    },
    {
      "state": "KY",
      "matches_full_window": 9,
      "matches_strict_post": 0,
      "drug_cost_full_window": 6918676.64,
      "opioid_prescribers_full_window": 3
    },
    {
      "state": "LA",
      "matches_full_window": 9,
      "matches_strict_post": 0,
      "drug_cost_full_window": 3024210.19,
      "opioid_prescribers_full_window": 4
    },
    {
      "state": "IA",
      "matches_full_window": 8,
      "matches_strict_post": 0,
      "drug_cost_full_window": 528833.44,
      "opioid_prescribers_full_window": 2
    },
    {
      "state": "CO",
      "matches_full_window": 8,
      "matches_strict_post": 0,
      "drug_cost_full_window": 352788.7,
      "opioid_prescribers_full_window": 1
    },
    {
      "state": "AL",
      "matches_full_window": 8,
      "matches_strict_post": 0,
      "drug_cost_full_window": 267680.75,
      "opioid_prescribers_full_window": 1
    },
    {
      "state": "MS",
      "matches_full_window": 8,
      "matches_strict_post": 0,
      "drug_cost_full_window": 259900.21,
      "opioid_prescribers_full_window": 2
    },
    {
      "state": "WA",
      "matches_full_window": 7,
      "matches_strict_post": 0,
      "drug_cost_full_window": 421617.33,
      "opioid_prescribers_full_window": 2
    },
    {
      "state": "MD",
      "matches_full_window": 7,
      "matches_strict_post": 0,
      "drug_cost_full_window": 2979401.5,
      "opioid_prescribers_full_window": 1
    },
    {
      "state": "CT",
      "matches_full_window": 5,
      "matches_strict_post": 0,
      "drug_cost_full_window": 333391.72,
      "opioid_prescribers_full_window": 1
    },
    {
      "state": "OR",
      "matches_full_window": 5,
      "matches_strict_post": 0,
      "drug_cost_full_window": 762447.49,
      "opioid_prescribers_full_window": 1
    },
    {
      "state": "NV",
      "matches_full_window": 5,
      "matches_strict_post": 0,
      "drug_cost_full_window": 800843.2,
      "opioid_prescribers_full_window": 1
    },
    {
      "state": "PR",
      "matches_full_window": 5,
      "matches_strict_post": 0,
      "drug_cost_full_window": 6494859.12,
      "opioid_prescribers_full_window": 1
    },
    {
      "state": "AZ",
      "matches_full_window": 4,
      "matches_strict_post": 0,
      "drug_cost_full_window": 151061.34,
      "opioid_prescribers_full_window": 2
    },
    {
      "state": "ME",
      "matches_full_window": 4,
      "matches_strict_post": 0,
      "drug_cost_full_window": 133240.13,
      "opioid_prescribers_full_window": 1
    },
    {
      "state": "IN",
      "matches_full_window": 4,
      "matches_strict_post": 0,
      "drug_cost_full_window": 768771.71,
      "opioid_prescribers_full_window": 1
    },
    {
      "state": "AR",
      "matches_full_window": 4,
      "matches_strict_post": 0,
      "drug_cost_full_window": 360739.56,
      "opioid_prescribers_full_window": 2
    },
    {
      "state": "MN",
      "matches_full_window": 3,
      "matches_strict_post": 0,
      "drug_cost_full_window": 51732.88,
      "opioid_prescribers_full_window": 1
    },
    {
      "state": "OK",
      "matches_full_window": 3,
      "matches_strict_post": 0,
      "drug_cost_full_window": 7665834.56,
      "opioid_prescribers_full_window": 2
    },
    {
      "state": "WV",
      "matches_full_window": 3,
      "matches_strict_post": 0,
      "drug_cost_full_window": 724474.18,
      "opioid_prescribers_full_window": 1
    },
    {
      "state": "WI",
      "matches_full_window": 3,
      "matches_strict_post": 0,
      "drug_cost_full_window": 161062.8,
      "opioid_prescribers_full_window": 1
    },
    {
      "state": "MA",
      "matches_full_window": 2,
      "matches_strict_post": 0,
      "drug_cost_full_window": 662.55,
      "opioid_prescribers_full_window": 1
    },
    {
      "state": "NH",
      "matches_full_window": 2,
      "matches_strict_post": 0,
      "drug_cost_full_window": 77918.66,
      "opioid_prescribers_full_window": 1
    },
    {
      "state": "NE",
      "matches_full_window": 2,
      "matches_strict_post": 0,
      "drug_cost_full_window": 1435.04,
      "opioid_prescribers_full_window": 0
    },
    {
      "state": "NM",
      "matches_full_window": 2,
      "matches_strict_post": 0,
      "drug_cost_full_window": 219196.22,
      "opioid_prescribers_full_window": 1
    },
    {
      "state": "SC",
      "matches_full_window": 2,
      "matches_strict_post": 0,
      "drug_cost_full_window": 865992.39,
      "opioid_prescribers_full_window": 1
    },
    {
      "state": "AK",
      "matches_full_window": 1,
      "matches_strict_post": 0,
      "drug_cost_full_window": 5585.89,
      "opioid_prescribers_full_window": 0
    },
    {
      "state": "DC",
      "matches_full_window": 1,
      "matches_strict_post": 0,
      "drug_cost_full_window": 5430.0,
      "opioid_prescribers_full_window": 1
    },
    {
      "state": "ID",
      "matches_full_window": 1,
      "matches_strict_post": 0,
      "drug_cost_full_window": 38968.57,
      "opioid_prescribers_full_window": 1
    },
    {
      "state": "WY",
      "matches_full_window": 1,
      "matches_strict_post": 0,
      "drug_cost_full_window": 76.69,
      "opioid_prescribers_full_window": 0
    },
    {
      "state": "HI",
      "matches_full_window": 1,
      "matches_strict_post": 0,
      "drug_cost_full_window": 3980.67,
      "opioid_prescribers_full_window": 1
    },
    {
      "state": "MT",
      "matches_full_window": 1,
      "matches_strict_post": 0,
      "drug_cost_full_window": 987.44,
      "opioid_prescribers_full_window": 0
    },
    {
      "state": "DE",
      "matches_full_window": 1,
      "matches_strict_post": 0,
      "drug_cost_full_window": 77651.54,
      "opioid_prescribers_full_window": 0
    },
    {
      "state": "RI",
      "matches_full_window": 1,
      "matches_strict_post": 1,
      "drug_cost_full_window": 107813.17,
      "opioid_prescribers_full_window": 1
    }
  ],
  "notes": "Per-state CSV at /api/v1/states/<state>/h30b-excluded-prescribing-partd.csv carries drug cost + claims + beneficiaries + opioid metrics + exclusion source. Opioid prescribing by federally-excluded NPIs is a particularly elevated signal because the 21st Century Cures Act and 2018 SUPPORT Act extended controlled-substance enforcement to specifically cover Medicaid/Medicare prescribers; this should feed directly into state PI + DEA referral queues."
}