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The Consistently Low Percentage of Medicare Enrollees Receiving Medication to Treat Their Opioid Use Disorder Remains a Concern

KEY RESULTS

Medicare enrollees continue to face challenges accessing medication to treat their opioid use disorder, with certain groups of enrollees facing even greater challenges than others.

Yet, for the first time, more than 600,000 enrollees received naloxone—the opioid overdose-reversal drug—through Medicare Part D, an important step toward reducing overdose-related deaths.

WHY OIG DID THIS REVIEW

Opioid-related overdose deaths remain near all-time highs. In 2022, there were an estimated 83,827 opioid-related overdose deaths in the United States. Most of these deaths involved synthetic opioids, such as illicit fentanyl. As such, the Office of Inspector General (OIG) continues to monitor access to treatment for opioid use disorder and the opioid overdose-reversal drug naloxone—both of which can save lives.

This data brief is a part of a series, released annually by OIG since 2017, that monitors indicators of the opioid epidemic in Medicare. It provides the most updated information on the number of enrollees experiencing opioid overdoses and the number receiving medication for opioid use disorder and overdose-reversal medications. It also monitors the use of prescription opioids and questionable prescribing in Part D.

WHAT OIG FOUND

About 52,000 people enrolled in Medicare experienced an opioid overdose during 2022. The exact number is likely higher, as additional enrollees may have overdosed who did not receive medical care billed to Medicare. Further, of the about 1.1 million enrollees who have opioid use disorder, just 18 percent received medication to treat their disorder. This low percentage highlights that enrollees are continuing to face challenges accessing treatment. In some States, the percentage of enrollees receiving treatment for their opioid use disorder was far lower than that for the Nation, with just 6 percent receiving medication in Florida. In addition, certain groups of enrollees—including those without the low-income subsidy-were less likely than others to receive medication. There are also notable disparities by race and ethnicity in those receiving medication.

On the other hand, the number of Part D enrollees receiving the opioid overdose-reversal drug naloxone grew to more than 600,000-an all-time high. Although reaching this high number is an important step toward reducing overdose-related deaths, there is also new concern. In 2023, Narcan—a brand-name naloxone—became available over-the-counter. Because of Narcan's change from prescription to over-the-counter status, manufacturers of generic equivalents of Narcan—i.e., 4 mg naloxone nasal sprays—must also now change their products to over-the-counter status. As a result, Narcan and its generic equivalents will no longer be covered by Medicare Part D. Without Part D coverage, enrollees will likely face higher out-of-pocket costs, which may create access barriers.

In addition, we found that key indicators of misuse or diversion of prescription opioids in Part D continue to decline. The number of Medicare enrollees who received high amounts of prescription opioids decreased from prior years, as did the number who received extreme amounts of opioids or who appear to be doctor shopping. Further, the number of prescribers with questionable prescribing remained about 100, similar to that for the prior 2 years.

WHAT OIG RECOMMENDS

As the opioid epidemic continues to take tens of thousands of lives each year, it is essential that the Centers for Medicare & Medicaid Services (CMS) and the Department continue to work to ensure access to medication to treat opioid use disorder and opioid overdose-reversal drugs. CMS and the Department have taken a number of actions to increase access to medication for opioid use disorder. However, the low percentage of enrollees receiving medication to treat their opioid use disorder calls for additional action.

OIG has made several recommendations to CMS in previous studies related to treatment. Notably, to encourage providers to treat more Part D enrollees who have opioid use disorder, OIG recommended that CMS inform providers about the use of buprenorphine—a common medication to treat opioid use disorder—and the low risk of diversion of this medication in Medicare. CMS should continue its efforts to implement these and other recommendations and to identify additional ways to improve access to medication to treat opioid use disorder for all Medicare enrollees who need it.

Further, as part of this data brief, OIG recommends that CMS educate enrollees and providers about options for access to overdose-reversal medications, as Narcan and its generic equivalents will no longer be covered by Part D. Depending on the enrollee's circumstances, these options may include receiving coverage of over-the-counter naloxone through certain States' Medicaid programs (if dually eligible). CMS concurred with our recommendation.