Recently, the United States Department of Health and Human Services Office of Inspector General (HHS OIG) released a data brief that monitors different indicators of the opioid epidemic in Medicare beneficiaries. The brief also serves to provide updated information on the number of enrollees that have experienced opioid overdoses and the number of beneficiaries that have received medication for opioid use disorder and overdose reversal medications.
The brief concluded that Medicare beneficiaries continue to face challenges in accessing medication to treat their opioid use disorder, with certain groups of beneficiaries facing greater challenges than others. The data found that overall, roughly 52,000 beneficiaries experienced reported opioid overdoses in 2022 and only 18% of the 1.1 million beneficiaries with opioid use disorder received medication for their condition, indicating hurdles in access to treatment. This is a problem because, as noted in the report, “medications to treat opioid use disorder have been shown to decrease illicit opioid use and opioid-related overdose deaths.”
Looking at the data on a state level, disparities were found to exist across state lines. For example, only 6% of beneficiaries in Florida received medication for opioid use disorder despite the state having the highest number of Medicare enrollees with opioid use disorder in the country. Other states with low levels of beneficiaries receiving medication for opioid use disorder included Texas, Kansas, and Nevada. Less than 10% of beneficiaries in the four states received medication to treat opioid use disorder, compared to 18% of beneficiaries nationwide.
Some other groups of beneficiaries that faced greater challenges in access to care included those who did not receive the low-income subsidy, those over the age of 65, and female beneficiaries.
Positive News in the Report
For positive news, the HHS OIG report found that for the first time, more than 600,000 enrollees received naloxone through Medicare Part D, “an important step toward reducing overdose-related deaths.” However, the report also noted that while Narcan was changed from a prescription medication to over-the-counter, this means that Narcan (and any generic equivalents) will not be covered by Medicare Part D, which may result in higher out-of-pocket costs for patients and in turn, create new access barriers.
The report also noted that key indicators of misuse or diversion of prescription opioids in Medicare Part D was on the decline, as was the number of Medicare beneficiaries who received high amounts of prescription opioids. The number of prescribers with “questionable prescribing” practices remained about the same for the past three years (last year and the two prior years).
HHS OIG Recommendations
HHS OIG recommended that the Centers for Medicare and Medicaid Services (CMS) and HHS work together to ensure access to medications to treat opioid use disorder and opioid overdose-reversal drugs. The report cited prior recommendations, including for CMS to encourage providers to treat more Part D enrollees with opioid use disorder and educate providers about buprenorphine and the low risk of diversion of the medication in Medicare.
HHS OIG also recommended that CMS continue to educate Medicare beneficiaries as well as health care providers about options for access to overdose-reversal medications – particularly important since these drugs will no longer be covered by Part D. In some states, dually-eligible patients may be able to receive coverage for over-the-counter naloxone through the state’s Medicaid program.