Medicare beneficiaries are not getting adequate support and treatment for opioid use disorder, the Department of Health & Human Services (HHS) declared in an annual report on Thursday.
In the report (PDF), the Office of Inspector General’s office said most of the deaths are due to fentanyl.
“Fewer than one in five Medicare enrollees with opioid use disorder received medication to treat their disorder,” the report reads.
In 2022, 1.1 million people enrolled in Medicare were diagnosed with the disorder. The proportion of the Medicare population that has received treatment is similar to 2021, with HHS speculating stigma and difficulties accessing providers that prescribe treatment as two possible reasons for complications.
Of the 18%, or 210,771 enrollees, who did receive treatment, they received either buprenorphine, methadone or naltrexone.
Some states, like Florida, Texas, Kansas and Nevada, had fewer than 10% of enrollees receive medication, lower than the national rate. In Florida, 160,586 Medicare enrollees have opioid use disorder.
Legislation to reauthorize the SUPPORT Act, an investment in community-based treatment and recovery programs, appears to be picking up steam. Earlier this week, the House voted overwhelmingly to reauthorize SUPPORT Act programs and permanently extend Medicaid coverage. The Senate also advanced its own reauthorization bill. Both the Senate’s and House’s versions of the bills were supported by the American Hospital Association.
The report found that only 9% of enrollees without the Part D low-income subsidy received medication, versus 26% of enrollees with the low-income subsidy. Data also showed that enrollees under the age of 65 were more likely to receive medication than older eligible members.
While 19% of white enrollees received medication, that number shrinks for other populations. Just 11% of Asian/Pacific Islander individuals received treatment and 15% of Black and Hispanic enrollees received treatment.
However, naloxone prescriptions grew to more than 600,000 enrollees, a figure that has mostly risen in recent years. In 2021, only 445,562 enrollees received naloxone, mainly through the brand-name drug Narcan.
Narcan is now an over-the-counter drug that is no longer covered by Medicare Part D. The report expects that out-of-pocket costs for enrollees will increase for members that want Narcan or a generic equivalent. A generic naloxone nasal spray will soon not be covered by Part D. Injectable naloxone will remain covered through Part D.
“Enrollees with the low-income subsidy paid an average of about $2 in cost-sharing for Narcan and its generic equivalents in 2022, while other enrollees paid an average of $29,” the report explained. “In contrast, Narcan’s manufacturer stated that its suggested price for over-the-counter Narcan is $44.99.”
Some Medicare Advantage plans may cover naloxone, and some states cover the drug if an individual is dually enrolled in Medicare and Medicaid.
The OIG recommends that the Centers for Medicare & Medicaid Services (CMS) inform providers about using buprenorphine and OTC naloxone through state Medicaid programs.
In 2022, more than 83,000 deaths in the U.S. were because of opioid-related overdose, according to the CDC. About 52,000 of those individuals were enrolled in Medicare, though that number could be higher.
https://www.fiercehealthcare.com/payers/medicare-enrollees-struggle-access-opioid-treatments-hhs
