Despite an “urgent” need for Medicare beneficiaries to receive treatment for opioid use disorder (OUD), a low percentage receive potentially life-saving medication-assisted treatment (MAT) for the condition.
Approximately 52,000 Medicare enrollees experienced an opioid overdose in 2022, according to a report from the Office of Inspector General (OIG). However, only 18% of Medicare patients with OUD received MAT. For certain populations covered by Medicare, the number getting access to these effective therapies was even lower, with just 6% receiving MAT.
These findings demonstrate a slight increase in the percentage of Medicare enrollees who receive medication for OUD. In 2020, 16% of beneficiaries received MAT for OUD, compared to 2022’s 18%.
Research suggests that MAT is associated with lower rates of overdose and death, although fentanyl use complicates the treatment’s efficacy.
The OIG found that specific Medicare populations received MAT at much lower rates than the nationwide percentage, demonstrating significant disparities.
Older Medicare recipients were about 2.5 times less likely to receive MAT, the report found. Only 11% of enrollees age 65 or older received medication, while 29% of enrollees under 65 received the treatment.
The report also identified notable disparities related to race and ethnicity. People of races and ethnicities other than white were less likely to have received treatment, with 19% of white enrollees receiving the medications, contrasted with 15% of Hispanic and Black enrollees and 11% of Asian/Pacific Islander enrollees.
Race and ethnicity also impacted the settings in which enrollees received medication. Black and Hispanic enrollees were more likely than any other race or ethnicity to receive treatment via methadone, a drug with significant drawbacks when compared to buprenorphine or naltrexone.
“Typically, patients who receive methadone must travel each day to opioid treatment
programs to receive their doses,” the study’s authors wrote. “In contrast, buprenorphine and naltrexone can be prescribed in office-based settings and dispensed by pharmacies, making them more convenient than methadone. In addition, methadone generally has more stigma attached to it than does buprenorphine or naltrexone.”
There were also disparities related to the financial strain of the medication.
Enrollees without Medicare’s Part D low-income subsidy, which helps pay for Part D premiums and cost-sharing, were far less likely to receive medication for OUD, regardless of race and ethnicity, age or sex. Of enrollees who receive the subsidy, 26% received treatment, compared to 9% of enrollees without it.
Geographic location was also found to have a notable impact on MAT use. Only 6% of Florida’s Medicare enrollees received medication for OUD, making it the lowest out of any state. Fewer than 10% of beneficiaries received MAT in Texas, Kansas and Nevada.
While the OIG identified several significant disparities, it did find that more Medicare enrollees received naloxone, the opioid-reversal drug, than ever before.
More than 600,000 Medicare enrollees did receive the drug, but the OIG warned that costs for the life-saving drug could soon escalate.
Narcan, a brand name of naloxone, became available over-the-counter in 2023. It is, therefore, no longer covered by Medicare Part D, leaving Medicare beneficiaries to foot the higher bill for the drug.
The OIG also identified 101 providers who over-prescribed opioids, which is similar to the amount identified in the last two years. These prescribers ordered opioids for the highest number of enrollees at the highest risk for OUD, totaling 43,871 opioid prescriptions for enrollees at serious risk. These prescriptions resulted in almost $15 million of Part D costs.
Based on the report’s findings, the OIG recommended “direct action” to increase access to treatment.
Within the guidance was the suggestion for CMS to inform providers about buprenorphine and its low diversion risk. Additionally, the OIG advised CMS to create an action plan to address disparities within OUD treatment and to support States’ efforts to reduce barriers to MAT, especially among underserved populations.
