The opioid epidemic continues to impact communities across the United States, and Medicare beneficiaries are no exception. Recent findings from the Office of the Inspector General (OIG) for the U.S. Department of Health and Human Services highlight a stark reality: approximately 50,400 Medicare Part D beneficiaries experienced an opioid overdose last year. While some progress has been made in prescribing practices, the report reveals concerning gaps in Medicare opioid treatment for individuals diagnosed with opioid use disorder (OUD). Less than 20% of beneficiaries with OUD received medications proven to help manage their condition.
“There is clearly still cause for concern and vigilance, even as some positive trends emerge,” the authors wrote. “Monitoring opioid use and access to medications for the treatment of opioid use disorder as well as to naloxone are critical to addressing the opioid crisis.”
Prescription Trends Among Medicare Beneficiaries
In 2021, 23% of Medicare Part D beneficiaries received at least one opioid prescription, a slight decrease from 2020. Nearly 200,000 beneficiaries were prescribed high amounts of opioids, placing them at increased risk for dependence and overdose.
Overall, researchers estimate that about 1.1 million Medicare beneficiaries are diagnosed with OUD, yet fewer than 200,000 receive medications for treatment. This disparity highlights a major challenge in ensuring effective Medicare opioid treatment reaches those who need it most.
Barriers to Medication Access
Medication-assisted treatment (MAT) is a cornerstone of Medicare opioid treatment, but coverage limitations create obstacles:
- Methadone can only be administered or dispensed by licensed opioid treatment programs, and is not covered under Medicare Part D.
- Buprenorphine and naltrexone, however, are pharmacy-dispensed and are covered under Part D, making them more accessible.
These coverage gaps prevent many beneficiaries from receiving the full spectrum of Medicare opioid treatment options.
OIG Recommendations for Improving Access
The OIG report includes several recommendations to expand Medicare opioid treatment access:
- Increase outreach to educate beneficiaries about treatment options covered under Part D.
- Expand provider networks and opioid treatment programs to meet growing demand.
- Enhance data sharing across agencies to monitor opioid use trends.
- Address disparities to ensure equitable access to treatment.
By implementing these measures, the healthcare system can ensure that beneficiaries receive Medicare opioid treatment in a timely and effective manner.
The Cost of Limited Medicare Coverage
A major barrier remains the lack of coverage for residential or intensive outpatient substance use disorder (SUD) services. Expanding Medicare SUD coverage would cost about $1.9 billion annually, but the Legal Action Center estimates savings of $1.6 billion per year from reduced hospitalizations and medical costs.
“The lack of Medicare coverage for SUD treatment is penny wise and pound foolish,” said Ellen Weber, LAC’s senior vice president. “It leaves millions of beneficiaries without adequate treatment until conditions become acute.”
Expanding access to Medicare opioid treatment could help prevent emergencies, improve health outcomes, and reduce long-term costs.
Conclusion
The ongoing opioid crisis poses a serious threat to Medicare beneficiaries. Despite small improvements in prescribing, the majority of beneficiaries with OUD still lack access to Medicare opioid treatment. Closing this treatment gap requires policy reform, increased provider access, and expanded coverage for residential and intensive outpatient services.
By prioritizing evidence-based Medicare addiction treatment, the healthcare system can save lives, improve quality of life, and reduce overall healthcare costs for vulnerable populations.
