Many Medicare Beneficiaries Are Not Receiving Medication to Treat Their Opioid Use Disorder

WHY WE DID THIS REVIEW

Opioid-related overdose deaths in the United States are at an all-time high, reaching an estimated 70,000 deaths in 2020. As the country continues to struggle with the opioid crisis, it is critical that people who are suffering from opioid use disorder have access to treatment. The coronavirus disease 2019 (COVID-19) pandemic has made this need even more urgent, particularly because the toll it has taken on beneficiaries' mental health and the extent to which it has increased the number of beneficiaries suffering from opioid use disorder are not yet known.

Opioid use disorder-a problematic pattern of opioid use that leads to clinically significant impairment or distress-is a chronic disease that can be treated with certain medications. These medications have been shown to decrease illicit opioid use and opioid-related overdose deaths. The combination of these medications with behavioral therapy is referred to as medication-assisted treatment.

Medicare plays an important role in ensuring that beneficiaries with opioid use disorder have access to treatment. Three medications are approved for the treatment of opioid use disorder: buprenorphine, methadone, and naltrexone. Beneficiaries can receive these drugs in office-based settings or from opioid treatment programs. To prescribe or administer buprenorphine in office-based settings, providers must receive a waiver through the Substance Abuse and Mental Health Services Administration (SAMHSA). In addition, opioid treatment programs are the only outpatient settings allowed to administer and dispense methadone.

HOW WE DID THIS STUDY

We analyzed claims from Medicare Parts B, C, and D to determine the extent to which beneficiaries diagnosed with opioid use disorder received medication and behavioral therapy to treat their opioid use disorder through Medicare in 2020.

WHAT WE FOUND

About 1 million Medicare beneficiaries were diagnosed with opioid use disorder in 2020. Yet less than 16 percent of these beneficiaries received medication to treat their opioid use disorder, raising concerns that beneficiaries face challenges accessing treatment. Furthermore, less than half of the beneficiaries who received medication to treat their opioid use disorder also received behavioral therapy. These services may be provided in-person or via telehealth; however, the full extent to which beneficiaries use telehealth for behavioral therapy is unknown as Medicare does not require opioid treatment programs to report this information.

In addition, beneficiaries in Florida, Texas, Nevada, and Kansas were less likely to receive medication to treat their opioid use disorder than beneficiaries nationwide. Furthermore, Asian/Pacific Islander, Hispanic, and Black beneficiaries were less likely to receive medication than White beneficiaries. Older beneficiaries and those who did not receive the Part D low-income subsidy were also less likely to receive medication to treat their opioid use disorder.

WHAT WE RECOMMEND

These findings show a need to increase the number of Medicare beneficiaries receiving treatment for opioid use disorder. Accordingly, we recommend that CMS take these steps: (1) conduct additional outreach to beneficiaries to increase awareness about Medicare coverage for the treatment of opioid use disorder; (2) take steps to increase the number of providers and opioid treatment programs for Medicare beneficiaries with opioid use disorder; (3) assist SAMHSA by providing data about the number of Medicare beneficiaries receiving buprenorphine in office-based settings and the geographic areas where Medicare beneficiaries remain underserved; (4) take steps to increase the utilization of behavioral therapy among beneficiaries receiving medication to treat opioid use disorder; (5) create an action plan and take steps to address disparities in the treatment of opioid use disorder; and (6) collect data on the use of telehealth in opioid treatment programs. CMS concurred with four of our recommendations and did not explicitly indicate whether it concurred with two of our recommendations.