Fewer than one in five Medicare patients with a substance use disorder (SUD) receive medication-assisted-treatment (MAT), including popular options such as buprenorphine and methadone, to treat their condition. Still, the number of providers prescribing buprenorphine for Medicare beneficiaries rose by 32% in 2023.

This is according to a new report from the U.S. Department of Health and Human Services Office of Inspector General.

While nationally, overdose deaths have dropped 24% year-over-year per CDC data, opioid overdoses for Medicare patients have increased, according to the OIG.

“The low percentage of enrollees receiving medications for their opioid use disorder continues to raise concern,” the report states. “It may indicate that enrollees are facing ongoing challenges accessing treatment.”

Among the challenges cited, stigma enshrouds reasons that both providers may be willing to prescribe the medication and that patients are willing to seek treatment.

“In 2023, the Data-2000 waiver was eliminated, meaningfully expanding access to buprenorphine, at least in theory,” Cooper Zelnick, president of Groups Recover Together, told Behavioral Health Business. “The challenge, however, remains that most providers are uncomfortable serving this population in a primary care setting. This is especially true for high-risk populations, including Medicare beneficiaries struggling with OUD, who are often older adults with significant comorbidities. Even organizations whose primary mission is to serve those struggling with addiction often shy away from Medicaid and Medicare beneficiaries, as well as the highest-risk patients.”

Woburn, Massachusetts-based Groups Recover Together is a value-based care provider that offers its patients MAT and virtual or in-person group therapy through “technology-assisted treatment.”

Issues with continuing treatment are also a barrier for some patients. Only about 40% of Medicare enrollees prescribed buprenorphine for opioid use disorder (OUD) continued regular treatment for at least 6 months.

Medicare patients over 65, enrollees who identify as female, and patients who did not receive low-income subsidies and who have been diagnosed with opioid use disorder are among those least likely to receive buprenorphine for treatment.

Specifically, among the older adult population, more than 7 million were reported to have a substance use disorder in the last year, according to the Substance Abuse and Mental Health Services Administration.

State-by-state, there are also stark differences in who and how many patients receive medication for OUD treatment. Patients enrolled in Medicare in Florida, Texas and Nevada are least likely to be prescribed buprenorphine or a similar medication for treatment, while patients in Vermont, Maine, and Massachusetts are among the most likely to receive a prescription.

Prior to January 2020, opioid treatment programs that treat individuals with OUD using medication were not eligible to enroll in Medicare as providers. As part of President Trump’s Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities Act, put in place to expand this type of care during his first term, these providers were eligible to be paid under the new Medicare Part B benefit.

However, since then, major gaps have been identified in connecting the tens of millions of Americans who experience substance use disorders to treatment, with one study finding that only 15% of individuals who need this type of care receive it.

Just this March, the Trump administration also cut billions in funding and state grants designated for addiction and mental health care.

While overdose counts tick upward related to opioid use disorder, access to naloxone, also known as Narcan, is also being affected. Narcan and its generic equivalents accounted for 97% of naloxone dispensed in 2023. Medicare Part D will no longer cover the costs of the lifesaving medication since it has transitioned to a largely over-the-counter drug. According to the OIG report, the existing supply of Narcan and generic equivalents that are designated “prescription only” will continue to be covered until the supply runs out. Out-of-pocket costs for the medication are likely to rise without this coverage, making access for individuals receiving low-income subsidies even more difficult.

The report outlines two primary recommendations for the Centers for Medicare & Medicaid Services (CMS) to follow in response to these findings: to conduct outreach about Medicare coverage for OUDs, and increase education to enrollees regarding access to overdose-reversal medications since they will no longer be covered under Part D.