Medicare patients may have challenges accessing medication treatment for opioid use disorder, OIG says

Less than 16% of more than one million Medicare beneficiaries diagnosed with opioid use disorder in 2020 received medication to treat the condition, a new Office of Inspector General (OIG) report found. 

The OIG also found that though the combination of medication and behavioral therapy is recommended, less than one third of those who received medication in an office-based setting also received behavioral therapy, according to the report. However, at opioid treatment programs, behavioral therapy is required and was administered.

While not every beneficiary needs medication for opioid use disorder, the report acknowledged, the low percentage of those who received it may indicate difficulty in accessing it. Some potential explanations are delayed care due to the COVID-19 pandemic, a shortage of providers authorized to treat with medication or patients avoiding treatment for the condition due to stigma. 

The OIG relied on 2020 claims from Medicare Parts B, C and D for its analysis. Opioid-related overdoses reached their peak that same year.

RELATED: Drug overdoses surged during the pandemic. Providers are thinking outside the box to combat the opioid crisis

The vast majority of beneficiaries who received medication in office-based settings received buprenorphine. Yet because of complex regulatory requirements, these providers are not widely accessible. In 2018, 40% of U.S. counties had no provider with a buprenorphine waiver, something the OIG has previously flagged. 

Less than 4% of those who received medication in 2020 did so at opioid treatment programs. This may be because Medicare only began covering opioid treatment programs in 2020. The vast majority received methadone there. 

The report also found that beneficiaries in Florida, Texas, Nevada and Kansas were less likely to get medication than others nationwide. These states and Mississippi, Oklahoma, Louisiana and Alabama had the lowest numbers of providers with buprenorphine waivers in the U.S. Asian-Pacific Islander, Hispanic and Black beneficiaries were also less likely to receive medication than white beneficiaries. Older beneficiaries and those who did not receive the Part D low-income subsidy were much less likely to receive medication.

In response to these findings, the OIG recommends the Centers for Medicare & Medicaid Services (CMS) better educate beneficiaries about Medicare coverage of treatment for opioid use disorder, increase the number of providers, provide and collect better data on beneficiaries receiving treatment including through telehealth, encourage behavioral therapy and create an action plan to address disparities in treatment. The report noted that CMS explicitly agreed with all but two of its recommendations.