Only one-third of Medicaid enrollees with opioid use disorder (OUD) receive treatment, according to the U.S. Department of Health and Human Services Office of Inspector General.
Opioid addiction care provider Ophelia partnered with the health plan Highmark Wholecare to improve this statistic and extend OUD treatment access to people enrolled in Medicaid plans.
Through the new partnership, Highmark members who are enrolled in Medicaid and those who are dually enrolled in Medicaid and Medicare will have access to Ophelia’s telehealth OUD treatment services.
“Our expanded collaboration with Highmark Health through Highmark Wholecare members allows us to serve communities that continue to be severely impacted by the opioid epidemic,” Zack Gray, CEO and co-founder of Ophelia, said in a statement. “The more we can break down barriers to treatment, the faster we can provide effective medications and services to people living with OUD that can improve, even save, their lives.”
Pittsburgh, Pennsylvania-based Highmark Wholecare provides Medicare and Medicaid coverage to over 400,000 members.
Pennsylvania has experienced drug-related overdose deaths at a rate twice the national average. Additionally, 32% of insured Pennsylvanians live in a zip code without a publicly listed buprenorphine provider.
“Pennsylvania has been working to address the opioid crisis for years, with far too many barriers standing in the way of people seeking and receiving life-saving treatment,” Ellen Duffield, president and CEO of Highmark Wholecare, said in a statement. “Highmark Wholecare’s collaboration with Ophelia is helping course correct this crisis by providing access to comprehensive OUD care that our Medicaid and D-SNP members can receive quickly and safely.”
New York City-based Ophelia offers medication-assisted treatment (MAT), primarily in the form of Suboxone, and is licensed to provide treatment in 49 states and D.C. The company has raised more than $68 million in funding.
Ophelia initially partnered with Highmark Wholecare’s parent company, Highmark Health, in 2021, serving 2.9 million commercial Highmark members in Pennsylvania. The newly expanded partnership provides in-network access to Ophelia’s treatment to Highmark Wholecare’s 320,000 Medicaid members and 40,000 members enrolled in both Medicaid and Medicare insurance.
In-network access to substance use disorder (SUD) treatment is a key factor in patients staying in treatment, according to a new study published in Health Affairs by Ophelia.
Highmark has formed partnerships with other SUD providers in recent years, including with behavioral health provider Spring Health and alcohol use disorder (AUD) treatment provider Ria Health.
