The opioid epidemic continues to devastate communities across the U.S., yet only one-third of Medicaid enrollees with opioid use disorder (OUD) receive treatment, according to the U.S. Department of Health and Human Services Office of Inspector General. To combat this alarming gap in care, Ophelia, a leading provider of Medicaid opioid treatment telehealth, has partnered with Highmark Wholecare, a Pennsylvania-based health plan serving Medicaid and Medicare members.
The Urgent Need for Medicaid Opioid Treatment Telehealth
Despite the availability of medication-assisted treatment (MAT), such as Suboxone (buprenorphine/naloxone), many Medicaid enrollees face barriers to accessing care, including:
- Provider shortages – 32% of insured Pennsylvanians live in zip codes without a publicly listed buprenorphine provider.
- Stigma and logistical challenges – Many patients struggle with transportation, work schedules, or fear of judgment when seeking in-person treatment.
Medicaid opioid treatment telehealth has emerged as a vital solution, offering confidential, convenient, and effective OUD treatment from home.
How the Partnership Expands Access to Care
Through this expanded collaboration, Highmark Wholecare members will have in-network access to Ophelia’s Medicaid opioid treatment telehealth services, which include:
- FDA-approved medications (primarily Suboxone)
- Personalized care plans with licensed medical providers
- Ongoing support from care coordinators and counselors
Zack Gray, CEO and co-founder of Ophelia, emphasized the importance of this partnership:
“The more we can break down barriers to treatment, the faster we can provide effective Medicaid opioid treatment telehealth services to people living with OUD that can improve, even save, their lives.”
Why Telehealth Access Matters for Medicaid Patients
A recent Health Affairs study by Ophelia found that in-network access to substance use disorder (SUD) treatment significantly improves patient retention in care. By integrating Medicaid opioid treatment telehealth into Highmark Wholecare’s network, more members can receive affordable, continuous treatment without the burden of out-of-pocket costs.
Ellen Duffield, President and CEO of Highmark Wholecare, highlighted the impact:
“Pennsylvania has been working to address the opioid crisis for years, with far too many barriers standing in the way of people seeking and receiving life-saving treatment. This collaboration is helping course-correct this crisis through expanded Medicaid opioid treatment telehealth access.”
Highmark’s Commitment to Substance Use Disorder Treatment
Highmark has been actively expanding its substance use disorder (SUD) treatment network through partnerships with:
- Spring Health (behavioral health provider)
- Ria Health (alcohol use disorder treatment)
This latest collaboration with Ophelia reinforces Highmark’s dedication to combatting addiction through innovative, accessible care models like telehealth opioid treatment.
The Future of OUD Treatment Through Telehealth
With Ophelia licensed in 49 states and D.C., this model has the potential to scale nationally, offering hope to millions struggling with OUD. By leveraging telehealth opioid treatment, insurance partnerships, and evidence-based MAT, more patients can receive the care they need when and where they need it.
Key Takeaways
- Only 1 in 3 Medicaid enrollees with OUD receive treatment
- Highmark Wholecare and Ophelia are expanding Telehealth opioid treatment to 360,000 Medicaid and dual-eligible members
- Pennsylvania’s opioid crisis is severe, with overdose deaths at twice the national average
- In-network SUD care improves treatment retention, per a Health Affairs study
This partnership marks a critical step forward in addressing the opioid epidemic by removing barriers, expanding access, and saving lives.
What’s next? If successful, similar collaborations could pave the way for broader Medicaid-covered OUD treatment nationwide.
