The opioid crisis continues to devastate communities across the United States, and while efforts to combat the epidemic have been ongoing, certain populations, particularly Medicare beneficiaries, remain disproportionately affected. Despite the growing recognition of opioid use disorder (OUD) as a critical public health issue, a significant gap exists between the need for treatment and the actual availability of care for older adults and other vulnerable groups covered by Medicare. According to a report from the Office of Inspector General (OIG), approximately 52,000 Medicare enrollees experienced an opioid overdose in 2022. Shockingly, only 18% of those beneficiaries who struggled with OUD received Medicare opioid use disorder treatment.
While there was a slight increase in the percentage of Medicare beneficiaries receiving MAT—up from 16% in 2020 to 18% in 2022—this still represents a low uptake of a life-saving treatment. Medicare opioid use disorder treatment is widely regarded as one of the most successful interventions for opioid addiction, associated with lower rates of overdose and death. Yet, the fact that only a fraction of those who need this treatment are getting it calls for urgent action and closer examination of the barriers to care.
The MAT Treatment Gap: An Ongoing Challenge
Medication-assisted treatment (MAT) combines medications, such as buprenorphine, methadone, and naltrexone, with counseling and behavioral therapies to treat opioid addiction. This integrated approach is known to help individuals stabilize, reduce opioid cravings, and prevent relapse. According to research, MAT can significantly reduce the risk of overdose and death. Yet, despite the overwhelming evidence supporting its efficacy, the percentage of Medicare beneficiaries receiving MAT remains disturbingly low.
In 2022, while nearly 52,000 Medicare beneficiaries suffered from opioid overdoses, only 18% of those individuals received Medicare opioid use disorder treatment. This is a slight improvement from 2020, when just 16% of beneficiaries with OUD received MAT. While any increase in MAT access is a step in the right direction, the low percentage of individuals receiving this treatment points to a clear and urgent need to address barriers to care. This is especially critical given that the opioid epidemic has worsened with the increasing prevalence of fentanyl, which complicates treatment but underscores the importance of ensuring that effective therapies like MAT are more widely available.
A Closer Look at Disparities in MAT Access
One of the most concerning findings in the OIG report was the significant disparities in MAT access based on factors like age, race, ethnicity, financial status, and geographic location. These disparities highlight systemic issues that need to be addressed in order to ensure that all Medicare beneficiaries have equitable access to life-saving care.
Age and MAT Access
Older adults, particularly those aged 65 and older, were found to be much less likely to receive MAT compared to younger beneficiaries. While 29% of Medicare enrollees under the age of 65 received Medicare opioid use disorder treatment, only 11% of those aged 65 and older had access to the same treatment. This discrepancy may reflect barriers such as a lack of awareness about MAT as a treatment option, concerns about stigma, or difficulties navigating the healthcare system. Given that older adults often have multiple medical conditions, they may face additional challenges in accessing specialized addiction care.
Racial and Ethnic Disparities
Racial and ethnic minorities within the Medicare population were also less likely to receive MAT, further emphasizing the deep-rooted inequities in the healthcare system. According to the OIG report, 19% of white Medicare enrollees received Medicare opioid use disorder treatment, compared to just 15% of Hispanic and Black enrollees and 11% of Asian/Pacific Islander enrollees. Additionally, Black and Hispanic enrollees were more likely to receive methadone as their form of MAT, a treatment that requires daily visits to opioid treatment programs and carries greater stigma compared to other medications like buprenorphine or naltrexone. Methadone’s daily requirement for in-person visits makes it less convenient and more stigmatized, potentially discouraging individuals from seeking treatment.
Financial Barriers to Accessing MAT
Financial strain is another significant obstacle to receiving MAT, particularly for Medicare enrollees who do not qualify for the Part D low-income subsidy. The OIG found that only 9% of Medicare enrollees without the subsidy received Medicare opioid use disorder treatment, compared to 26% of those who were eligible for the subsidy. The high cost of MAT medications, particularly for individuals without financial assistance, poses a substantial barrier to treatment. While the low-income subsidy helps cover some of these costs, many beneficiaries still face out-of-pocket expenses that make MAT inaccessible.
Geographic Disparities: A Regional Crisis
Geographic location also plays a pivotal role in determining whether a Medicare beneficiary can access MAT. The OIG report highlighted significant regional differences in MAT access, with some states having alarmingly low rates of treatment. Florida, for example, had the lowest rate of MAT access, with only 6% of Medicare enrollees receiving Medicare opioid use disorder treatment. Other states, such as Texas, Kansas, and Nevada, also had MAT access rates under 10%. These disparities suggest that certain regions of the country, particularly rural and underserved areas, may lack the infrastructure and resources necessary to provide MAT services to all individuals in need. In these areas, there may be a shortage of trained providers, limited access to treatment facilities, and significant barriers to transportation that prevent beneficiaries from obtaining treatment.
Naloxone Access and the Rising Cost of Life-Saving Drugs
The OIG report also shed light on the increasing distribution of naloxone, the opioid-reversal drug, among Medicare enrollees. In 2022, more than 600,000 Medicare beneficiaries received naloxone, marking a significant increase in its availability. While naloxone is a critical tool in reversing opioid overdoses and saving lives, its rising cost is a growing concern. In 2023, Narcan, a brand name of naloxone, became available over-the-counter, meaning it is no longer covered by Medicare Part D. This policy change could place an additional financial burden on Medicare beneficiaries, who may struggle to afford the higher out-of-pocket costs for this life-saving medication.
Over-Prescribing of Opioids: A Persistent Problem
In addition to the under-treatment of OUD with MAT, the OIG report also identified a troubling issue: the over-prescribing of opioids. The report highlighted 101 providers who were over-prescribing opioids, resulting in nearly $15 million in Part D costs. These providers issued opioids to enrollees who were at high risk for developing OUD, contributing to the ongoing crisis. The over-prescribing of opioids underscores the need for stronger regulatory oversight and better education for healthcare providers about the risks associated with opioid prescriptions.
Recommendations for Action
The OIG’s report calls for urgent “direct action” to improve access to MAT and reduce disparities in treatment for OUD. The recommendations outlined in the report focus on increasing education, improving accessibility, and addressing the financial and geographic barriers that prevent beneficiaries from accessing the care they need.
Some of the key recommendations include:
- Provider Education: The Centers for Medicare and Medicaid Services (CMS) should enhance efforts to educate providers about MAT, particularly the benefits of buprenorphine, which has a lower risk of diversion compared to methadone. Providers should be encouraged to prescribe MAT in office-based settings, where it is more convenient and less stigmatized for patients.
- Addressing Disparities: CMS should develop and implement an action plan to address the disparities in access to Medicare opioid use disorder treatment, particularly among older adults, racial and ethnic minorities, and individuals in low-income or rural areas.
- State-Level Support: CMS should work closely with states to reduce barriers to MAT access, providing support for local initiatives that aim to increase treatment availability in underserved regions.
- Improving Access to Naloxone: To prevent overdose deaths, CMS should ensure that Medicare beneficiaries continue to have access to naloxone at affordable prices, even as it becomes available over-the-counter.
Conclusion
The opioid crisis continues to ravage communities, and for Medicare beneficiaries, the lack of access to effective treatment options such as MAT exacerbates the problem. The OIG’s findings underscore the urgent need for action to improve access to Medicare opioid use disorder treatment and address the disparities that prevent many beneficiaries from receiving life-saving care. By implementing the recommended changes and addressing the barriers to treatment, we can ensure that more Medicare beneficiaries receive the help they need to overcome opioid use disorder and lead healthier, more fulfilling lives.
