Companies that treat opioid use disorder could commend themselves last month when the federal government reported overdose deaths were down nearly 11% for the first eight months of 2024, marking the second-straight year of decline.

“It’s fantastic news,” Jason Kletter, president of BayMark Health Services, told Addiction Treatment Business. “It’s something to celebrate.”

But the Centers for Disease Control and Prevention (CDC) numbers also point to concerns.

For one, those aged 65 and older saw an increase in fatal overdoses, including a 9% climb in the last six months of 2023. An increase in elderly overdoses come as Medicare Advantage patients struggle to access medication for opioid addiction, according to a U.S. Department of Health and Human Services Office of Inspector General (HHS-OIG) report released last month.

ATB spoke with Kletter about where opioid treatment providers have made strides, and where there are gaps to fill.

Headquartered in Lewisville, Texas, BayMark lays claim to being the largest opioid treatment provider in the U.S. with over 400 facilities across 35 states. The company has grown since a 2015 investment by Webster Equity Partners.

But BayMark has not entered some pockets of the country because it is not a good business decision, Kletter said.

“If you’re going to pay for rent and a physician, nurse, and counselor, you need to have a minimum threshold of services that you can bill for,” Kletter said.

The OIG report highlighted rural areas in Georgia, Kansas and western Texas where no providers prescribe methadone or buprenorphine. The report calls on the U.S. Centers for Medicare & Medicaid Services (CMS) to geographically target counties with scant treatment options, a recommendation Kletter would like CMS to carry through.

“We’ve suggested to CMS for a few years that they create an enhanced rate in rural areas that are more than a certain geographic distance from the existing treatment facility,” Kletter said.

BayMark runs residential and intensive outpatient opioid treatment programs. It also operates offices whose focus can be prescribing medication. Around 70% of the company’s office-based providers accept Medicare and Medicaid, Kletter said, but for the other providers “the economics don’t work right.” In some cases, that’s because “the state doesn’t create a reasonable Medicaid reimbursement.”

The OIG report, which surveyed providers in 2022, highlighted that only 37% of office-based providers prescribed buprenorphine to a Medicaid enrollee.

“There are stand-alone private practice doctors” dotting the country who are authorized to prescribe opioid medication, Kletter said, but cannot get Medicaid to pay the cost.

The OIG report called on CMS to work with states in ensuring reimbursement rates are sufficient to recruit and retain providers.

Another issue hindering access are the rules around Medicare Advantage, the publicly subsidized health plans for seniors that are intended to work like private insurance. Under Medicare Advantage, a patient must get authorization from their primary care provider for medication-assisted opioid treatment.

“If a patient is required to get a primary care referral and we can’t get it in time, it’s not uncommon for the patient to give up, and we lose them back to drug use,” Kletter said.

Kletter called prior authorization “a huge problem,” which CMS must address.

For its part, CMS Administrator Chiquita Brooks-LaSure wrote a response to the HHS-OIG report that noted an overall increase in patient access toward opioid treatment medications, a point Kletter said is indisputable.

Brooks-LaSure stated that the federal government should first provide more information, including an updated Substance Abuse and Mental Health Service Administration database on opioid treatment locations, and a published analysis comparing Medicaid reimbursement between states.