OIG Report Suggests Medicare Beneficiaries May Struggle to Access MAT, Naloxone

A new report from the Office of Inspector General (OIG) suggests Medicare beneficiaries could be struggling to access medication-assisted treatment (MAT) and opioid overdose reversal drugs like naloxone. 

The OIG found that nearly 25% of all Part D beneficiaries were prescribed opioids last year — and more than 43,000 Part D beneficiaries suffered some type of opioid overdose in 2020. 

But, at the same time, the number of beneficiaries who received MAT drugs increased at a slower rate in 2020 than in years past. Plus, the number of beneficiaries receiving prescriptions for naloxone through Part D didn’t grow at all last year. 


“These changes are likely related to COVID-19 — patients may have avoided seeing their health care providers during the pandemic, reducing the opportunity for providers to offer treatment,” OIG said in the report. “The slower growth rates in the numbers of beneficiaries receiving MAT drugs and naloxone add to ongoing concerns about access to MAT drugs and naloxone.”

The OIG recommended that the Centers for Medicare & Medicaid Services (CMS) educate Part D beneficiaries and providers about MAT drugs and naloxone in an attempt to expand treatment access. 

The call to improve behavioral health access for Medicare beneficiaries is nothing new, as the federal health insurance program leaves a lot to be desired in terms of mental health and substance use disorder (SUD) treatment coverage. 


A big reason for that is that Medicare is not bound by the Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA), which prohibits insurers from covering behavioral health services more restrictively than those in the medical and surgical realm.

Because of that, Medicare beneficiaries’ behavioral health treatment options are limited. 

For example, they have a 190-day lifetime coverage limit on inpatient psychiatric care, and most community-based services delivered by SUD treatment facilities are not reimbursed by Medicare. Plus, many clinician types — such as licensed counselors, certified addiction counselors and peer counselors — are not authorized Medicare providers.

“Those are parity issues, and we feel the federal government should not continue to have blatant exclusions or caps that they’ve prohibited in the private sector,” National Association for Behavioral Healthcare (NABH) President and CEO Shawn Coughlin previously told BHB.