Despite overdoses of 50,000, number of Medicare beneficiaries receiving MAT OUD treatment remains low

Last year, about 50,400 Medicare Part D beneficiaries suffered an opioid overdose.

This is according to a new report from the Office of the Inspector General of the U.S. Department of Health and Human Services. The report also found that less than 20% of Medicare beneficiaries with opioid use disorder (OUD) received medication to treat their condition.

“There is clearly still cause for concern and continued vigilance, although some positive trends are emerging,” the research authors wrote. “Monitoring opioid use and access to medications for the treatment of opioid use disorder as well as naloxone are key to addressing the opioid crisis.”

About 23% of Medicare Part D beneficiaries received at least one opioid prescription in 2021. This is down one percentage point from 2020. The report found that nearly 200,000 Medicare Part D beneficiaries received large amounts of opioids in 2021.

Researchers report that approximately 1.1 million Medicare beneficiaries are diagnosed with OUD. But less than 200,000 receive medication to treat their OUD.

“Methadone for the treatment of opioid use disorder cannot be administered or

provided by opioid treatment programs,” the report said. “Because methadone for the treatment of opioid use disorder is not dispensed by a pharmacy, it is not covered by Part D.”

Other OUD drugs, including buprenorphine and naltrexone, can be dispensed by a pharmacy and are covered under Part D.

In December, the OIG released a report recommending a number of actions for the Centers for Medicare and Medicaid. He suggested additional outreach to Medicare beneficiaries about their OUD treatment coverage.

The OIG also called for more providers and opioid treatment programs for people with TOU and more data sharing between government agencies. An action plan to address disparities in the treatment of TOU was also recommended.

Medicare does not cover intensive residential or outpatient services for substance use disorders (SUD). A recent report from the Legal Action Center (LAC) found that expanding the scope of Medicare SUD coverage would cost approximately $1.9 billion per year.

It also predicts that covering more services would save an estimated $1.6 billion annually due to decreased medical costs and hospitalizations associated with SUD.

“The lack of Medicare coverage for SUD treatment is a reasonable sum and an insane pound,” said Ellen Weber, LAC’s senior vice president for health initiatives, in a statement. “This leaves millions of recipients without adequate treatment for their substance use disorder until their condition becomes acute enough to require hospitalization.”

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