Opioid use disorder (OUD) continues to be a devastating public health crisis in the United States, making effective and sustained treatment essential. One of the biggest challenges in OUD care is ensuring patients remain engaged long enough to benefit fully from treatment. Recent research highlights that in-network opioid treatment retention plays a pivotal role in improving patient outcomes.
A new study published in Health Affairs by Ophelia, a leading provider of substance use disorder care, analyzed how insurance coverage influences retention rates. The study found that patients with in-network opioid treatment support stayed in care significantly longer than those without it, underscoring the importance of insurance networks in treatment success.
Study Insights: Why In-Network Coverage Matters for Treatment Retention
The study reviewed data from 3,842 patients receiving medication-assisted treatment (MAT) for OUD through Ophelia’s virtual care platform. Among them, 1,613 patients had access to in-network opioid treatment retention benefits, while 2,229 were either uninsured or paying out-of-network fees.
Key findings showed:
- 72.3% of patients with in-network opioid treatment benefits remained in treatment for at least 180 days.
- Only 48.1% of out-of-network or uninsured patients maintained care for the same period.
This difference highlights how having in-network opioid treatment retention coverage reduces financial barriers and helps patients sustain engagement.
Financial Barriers and Their Impact on Retention
Cost is a major factor influencing whether patients stay in treatment. The study found that uninsured patients paying a flat fee of $195 monthly were somewhat more likely to stay than those paying out-of-network. However, patients benefiting from in-network opioid treatment retention were 50% more likely to remain in care at six months compared to cash-pay patients.
Importantly, the disparity in retention rates remained when comparing insured patients in-network versus out-of-network, signaling that access to in-network opioid treatment benefits directly impacts patient outcomes beyond just financial differences.
Expert Perspective: Eliminating Barriers to Care
Dr. Arthur Robin Williams, Chief Medical Officer of Ophelia, stated:
“When people are ready to seek OUD treatment, there should be no financial hurdles preventing them from receiving care. This study is a call to our healthcare system to expand in-network opioid treatment retention opportunities and include telehealth providers to make care more affordable and accessible.”
His remarks emphasize the need to widen insurance networks to improve in-network opioid treatment rates, especially given the rising importance of telehealth in OUD care.
Medicaid and Its Role in Treatment Access
Medicaid remains the largest payer of addiction care in the U.S., particularly covering vulnerable populations at higher risk for OUD. The study noted that Medicaid beneficiaries are four times more likely to have OUD than the general population.
The recent end of COVID-19-related Medicaid enrollment pauses threatens in-network opioid treatment retention for many, potentially disrupting access to care. Ensuring Medicaid patients can remain in-network is crucial to sustaining long-term treatment retention and combating the opioid crisis.
Why Treatment Retention Is a Lifeline
Sustained engagement in treatment, such as 180-day retention benchmarks, is strongly linked to better recovery outcomes. Patients who lose access to in-network opioid treatmentbenefits are at higher risk for relapse, overdose, and discontinuation of care.
This study makes clear that in-network opioid treatment retention is not merely a matter of convenience — it is essential for saving lives.
Telehealth and the Future of In-Network Care
Telehealth has expanded access to OUD treatment dramatically, but insurance coverage limits remain a challenge. Expanding in-network opioid treatment to include more telehealth providers would make care more accessible and affordable, improving outcomes for many patients.
Conclusion: A Call to Action for Expanding In-Network Access
The evidence from Ophelia’s study is clear: expanding in-network opioid treatment retention benefits is critical to improving patient retention and success in OUD treatment. Healthcare systems and policymakers must reduce financial barriers and broaden insurance networks to support ongoing, accessible care—especially through telehealth.
By prioritizing in-network opioid treatment, we can help more patients maintain treatment continuity and move toward lasting recovery.
If you or a loved one is seeking OUD treatment, be sure to understand your insurance coverage and look for providers offering strong in-network opioid treatment support to maximize your chances of success.
