Report Shows Limited Access to Opioid Use Disorder Treatments for Medicare Beneficiaries

More than 50,000 Medicare Part D beneficiaries experienced an opioid overdose in 2021, while almost a quarter of Part D enrollees (12.1 million) received at least one prescription opioid through Medicare, according to a recent report from the HHS Office of Inspector General.

The proportion of beneficiaries receiving opioids has been declining, from 33% in 2016 to 23% in 2021. Alabama saw the highest proportion of opioid recipients (36%), while New York and Hawaii ranked the lowest (15%).

In 2021, nearly 200,000 Part D enrollees received high amounts of opioids, compared with 501,008 enrollees in 2016. Those enrollees received an average morphine equivalent dose of greater than 120mg a day for at least three months. Meanwhile, about 23,000 enrollees were at serious risk of misuse or overdose as they received extreme amounts of opioids or appeared to be doctor shopping. The numbers have been on a downward trend for several years, reflecting an overall decline in opioid prescribing since 2016.

More than 1.1 million Medicare beneficiaries had a diagnosis of opioid use disorder in 2021, and only about 18% of them received one of three recommended medications — buprenorphine, methadone and naltrexone — to treat their opioid use disorder in an outpatient setting. Among them, nearly three-quarters (141,327 beneficiaries) received the medication in an office-based setting, with 95% receiving buprenorphine.

Meanwhile, a small number of enrollees received their treatments from opioid treatment programs in 2021, which were the only providers permitted to administer methadone to treat the disorder.

The number of enrollees getting prescriptions for naloxone — a drug that could block the effects of an opioid overdose — grew significantly, from 377,549 in 2020 to 445,561 in 2021. Despite some emerging positive trends, the report highlighted the importance of monitoring opioid use and ensuring access to medications for Medicare beneficiaries.

NOTE: Beneficiaries and percentages do not sum to the total and 100%, respectively, because some beneficiaries received more than one type of medication or received the treatments from both settings.

SOURCE: “Opioid Overdoses and the Limited Treatment of Opioid Use Disorder Continue To Be Concerns for Medicare Beneficiaries,” U.S. Department of Health and Human Services Office of Inspector General.

This infographic was reprinted from AIS Health’s biweekly publication RADAR on Drug Benefits.

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