Medicare beneficiaries lack access to opioid treatments
Of the roughly 1.1 million enrollees who have opioid use disorder, just 18% receive medication to treat it, OIG said.
Photo: Willie B. Thomas/Getty Images
Medicare beneficiaries aren't getting the treatments they need for opioid use disorder and many are dying due to fentanyl, with fewer than one in five enrollees receiving medication to treat their disorder, according to a new report from the Department of Health and Human Services.
The department's Office of the Inspector General found that at least 52,000 Medicare enrollees experienced an opioid overdose in 2022, though the exact number is likely higher since many beneficiaries didn't receive medical care that was billed to Medicare.
Of the roughly 1.1 million enrollees who have opioid use disorder, just 18% received medication to treat it. This highlights ongoing access challenges, OIG said, and the problem is worse in certain states, such as Florida, in which only 6% of enrollees received medication treatment.
On top of that, certain groups of enrollees, including those with low-income subsidies, were less likely than others to receive the medication. Disparities along racial and ethnic lines also emerged.
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. While OIG viewed that as an important step toward reducing opioid deaths, there's a 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 – such as 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.
OIG also 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. And the number of prescribers with questionable prescribing remained about 100, similar to that for the prior two years.
WHAT'S THE IMPACT
Opioid-related overdose deaths remain near all-time highs. In 2022, there were an estimated 83,827 opioid-related overdose deaths in the U.S., according to OIG's internal data. Most of these deaths involved synthetic opioids, such as illicit fentanyl.
As the opioid epidemic continues to rage, OIG said it's essential that the Centers for Medicare and Medicaid Services and HHS 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," the report said. "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. 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," OIG said.
The agency is also recommending 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 has concurred with the recommendation, OIG said.
THE LARGER TREND
HHS, through its Substance Abuse and Mental Health Services Administration, awarded almost $48 million in grants in July to combat multiple facets of substance misuse and the nation's opioid epidemic.
The grant awards are part of ongoing federal efforts in prevention, treatment, recovery support and harm reduction – the pillars of the HHS Overdose Prevention Strategy. The Overdose Prevention Strategy is meant to advance the Biden administration's National Drug Control Strategy, which delivers on the call to action in President Biden's Unity Agenda for a whole-of-government approach to beat the overdose epidemic.
That isn't the first time HHS has allocated grant funding to programs geared toward addressing the opioid crisis. In September 2022, HHS awarded more than $1.6 billion in investments for communities throughout the country to address the addiction and overdose crisis.
Twitter: @JELagasse
Email the writer: Jeff.Lagasse@himssmedia.com
