The report outlines persistent barriers hindering Medicare enrollees’ access to vital Opioid Use Disorder (OUD) treatments. With only 18% receiving medication, disparities persist among racial groups and low-income beneficiaries. Naloxone accessibility increased, yet concerns arise due to its shift to over-the-counter status. Cost implications loom as beneficiaries might face out-of-pocket expenses. While positive trends emerged, including reduced opioid diversions, challenges remain. The need for CMS action to tackle treatment disparities is urgent, emphasizing the importance of educating beneficiaries about potential out-of-pocket costs.
Medicare enrollees face substantial challenges in accessing crucial Opioid Use Disorder (OUD) treatments. The Office of Inspector General (OIG) report highlights concerning trends, with only 18% of beneficiaries receiving necessary medication. Disparities persist among racial groups and low-income individuals, exacerbating treatment access issues. Despite increased access to naloxone, its transition to over-the-counter status raises concerns about affordability. Addressing these barriers is critical to ensure equitable access to treatment. This report sheds light on disparities and encourages action by healthcare authorities to mitigate these challenges.
According to the report, approximately one million Medicare enrollees grapple with OUD. However, a mere 18 percent of them received medication for OUD treatment. This finding highlights persistent obstacles in accessing Medication-Assisted Treatment (MAT), which employs medications such as buprenorphine and methadone to mitigate withdrawal symptoms and support recovery.
The report, an annual publication since 2017, sheds light on disparities in treatment access. Specifically, it points to disparities faced by Black, Hispanic, Asian/Pacific Islander, low-income, and over-65 beneficiaries, exacerbating the challenge of accessing essential OUD treatments.
MAT is recognized as the gold standard for OUD treatment, yet access to these crucial medications remains suboptimal, as indicated by the OIG report. Alarmingly, amidst a staggering count of approximately 52,000 opioid overdoses in the Medicare population in 2022, only around a fifth of individuals in need of OUD medication treatment received it.
The disparities become starker when broken down demographically: Black and Hispanic individuals received treatment at rates of 15 percent and Asian/Pacific Islander individuals at 11 percent. Moreover, beneficiaries receiving low-income subsidies faced considerable barriers, with only 9 percent accessing OUD medication treatment, while the figure stood at 11 percent for those aged 65 and older.
Florida emerged as the state with the lowest proportion (6 percent) of Medicare enrollees receiving medication treatment for OUD, underscoring the pervasive nature of treatment challenges across different regions.
The report highlights various barriers to access, including the lack of access to providers who can prescribe OUD treatment medication and the presence of social stigma, hindering individuals from seeking necessary treatment.
Despite these challenges, the report identified some positive developments. Notably, there was a substantial increase in Part D prescriptions for naloxone, reaching a record-high of 600,000 in 2022—a significant rise from just over 445,000 prescriptions in the preceding year. Naloxone serves as a crucial agent in reversing opioid overdoses.
However, concerns linger regarding naloxone accessibility following the approval of the over-the-counter version of the brand-name drug Narcan. With Narcan transitioning to OTC status, it becomes ineligible for Part D coverage. This shift might potentially affect generic versions of naloxone, compelling beneficiaries to incur out-of-pocket expenses, posing potential cost barriers. The expected price hike of Narcan, slated to retail for $44.99, could further exacerbate these challenges.
The report refrained from making specific drug pricing recommendations but emphasized the importance of educating Medicare beneficiaries about anticipated out-of-pocket expenses for naloxone.
Additionally, the report highlighted positive trends, such as a decline in opioid diversions and a consistent number of providers prescribing opioids to high-risk patients. However, it also noted persistent concerns, including a consistent number of providers prescribing opioids to high-risk patients from 2021 to 2022.
OIG recommended that healthcare providers treating Medicare beneficiaries with OUD impart education regarding the anticipated out-of-pocket expenses for naloxone. Moreover, it stressed the urgency for the Centers for Medicare and Medicaid Services (CMS) to devise an action plan to address disparities in OUD medication treatment.
While progress is evident with heightened naloxone accessibility and reduced opioid diversions, challenges in Medicare OUD treatment persist. Disparities among beneficiaries, compounded by naloxone’s shift to over-the-counter status, threaten affordability. The need for action to address treatment disparities, particularly among marginalized groups, is paramount. Educating beneficiaries about potential out-of-pocket costs becomes crucial. This report underscores the urgency for the Centers for Medicare and Medicaid Services (CMS) to formulate strategies for equitable OUD treatment access. Bridging these gaps is essential to ensure comprehensive and accessible care for Medicare enrollees grappling with OUD.
