Medicare patients challenged to access opioid-use-disorder medication, OIG finds

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While more than 1 million Medicare beneficiaries had a diagnosis of opioid-use disorder in 2020, less than 16% of those beneficiaries received medication to treat their condition, according to a new report from the Office of Inspector General. They accounted for fewer than 1 in 6 of all Medicare beneficiaries with opioid-use disorder.

Each of these 167,734 beneficiaries received at least one of the three approved drugs to treat opioid-use disorder: buprenorphine, methadone and naltrexone. The Food and Drug Administration recommends that all three of these drugs be available to all patients because certain medications may be more appropriate for some than others.

The low proportion of beneficiaries with opioid-use disorder receiving medication-assisted treatment (MAT) drugs through Medicare raised the OIG's concern. MAT drugs may not be medically necessary for all these beneficiaries, but the low proportion may indicate that beneficiaries have challenges accessing treatment for opioid-use disorder despite Medicare's new coverage of opioid-treatment programs in 2020. 

These challenges may be due to various factors, OIG found. Researchers found there are gaps between the number of providers who are authorized to treat patients with opioid-use disorder with medication and the number of patients who need care. Plus, many people may also avoid seeking treatment due to the stigma associated with opioid-use disorder. Treatment avoidance has only been exacerbated by the ongoing COVID-19 pandemic.

Geographic disparities emerged in the data. Beneficiaries in Florida, Texas, Kansas and Nevada were two to three times less likely to receive medication to treat their opioid-use disorder. In each of these states, less than 8% of the beneficiaries with opioid-use disorder received MAT drugs, compared with about 16% nationwide.

Florida and Texas had the lowest percentage of beneficiaries. In Florida, just 5% of beneficiaries with opioid-use disorder received MAT drugs through Medicare. In Texas, only 6% did.

There are also notable racial and ethnic disparities in medication for opioid-use disorder. Lower percentages of Asian/Pacific Islander, Black and Hispanic beneficiaries received MAT drugs to treat their opioid-use disorder than white beneficiaries. About 10% of Asian/Pacific Islander, 12% of Hispanic and 13% of Black beneficiaries received medication, compared with 17% of white beneficiaries.

Also, older beneficiaries – those aged 65 and older – were far less likely to receive MAT drugs than those under the age of 65. Younger beneficiaries often qualify for Medicare because of disability and account for almost half of beneficiaries with opioid-use disorder. 

Additionally, female beneficiaries were also less likely to receive medication to treat their opioid-use disorder than male beneficiaries, and beneficiaries not receiving the Part D low-income subsidy were less likely to receive medication to treat their opioid-use disorder than those receiving the subsidy. 

WHAT'S THE IMPACT?

Opioid-related overdose deaths in the U.S. are at an all-time high, reaching an estimated 70,000 in 2020, according to OIG. 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, OIG found.

OIG recommends that the Centers for Medicare and Medicaid Services conduct additional outreach to beneficiaries to increase awareness about Medicare coverage for the treatment of opioid-use disorder, take steps to increase the number of providers and opioid treatment programs for Medicare beneficiaries, take steps to increase the utilization of behavioral therapy, and create an action plan and take steps to address disparities in the treatment of opioid-use disorder.

THE LARGER TREND

In 2019, buprenorphine was found by Mayo Clinic Proceedings to be one of three FDA-approved drugs that are underused in helping patients combat opioid addiction. Patient compliance with buprenorphine, that analysis found, is relatively high and associated with improved rates of sobriety and a reduction in accidental overdoses.

The opioid epidemic has long been a challenging issue, both for Americans and the healthcare system that treats them, and the mortality statistics are significant. The American Academy of Family Physicians published research in 2019 showing that, if there's no change in the annual incidence of prescription opioid misuse, annual opioid deaths could hit 82,000 by 2025.

From finding new, more cost-effective care-delivery models to establishing outpatient addiction-treatment programs, there's an opportunity for investors to pump some much-needed cash into the efforts to curb opioid misuse. If done correctly, the investors can see a healthy ROI, while also helping patients with addiction issues and easing the burden on the healthcare system.

Twitter: @JELagasse
Email the writer: jeff.lagasse@himssmedia.com