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Medication Access for OUD Abysmal for Medicare Enrollees

While the number of Medicare enrollees with medication access for OUD still remains low, OIG reported a promising increase in naloxone access.

About a million Medicare enrollees have opioid use disorder (OUD), but only 18 percent of them received medication to treat OUD, according to a new Office of Inspector General report that illustrates continued medication assisted treatment (MAT) access problems.

The report, published on an annual basis since 2017, also revealed disparities in OUD treatment access, with Black, Hispanic, Asian/Pacific Islander, low-income, and over-65 beneficiaries facing greater challenges.

MAT is considered the gold standard in OUD treatment, using different drugs like buprenorphine and methadone to help abate withdrawal symptoms in patients and aid in the recovery process.

But access to those medications is still less than desirable, the OIG report showed, even as the nation saw around 52,000 opioid overdoses among the Medicare population in 2022.

Only around a fifth of the folks who need OUD medication treatment received it in 2022, the report showed. For Black and Hispanic people, that number is 15 percent, and for Asian/Pacific Islander people, it’s 11 percent. Medicare beneficiaries who received a low-income subsidy also saw access barriers, with only 9 percent getting medication treatment for OUD, while 11 percent of those 65 and older could say the same.

The state with the lowest proportion of Medicare enrollees getting medication treatment for OUD was Florida, with 6 percent of those who needed it getting treatment.

“This low percentage highlights that enrollees are continuing to face challenges accessing treatment,” OIG said in a report summary.

Such barriers may include access to a provider who can prescribe OUD treatment medication and stigma, the agency offered.

When patients did get access to OUD treatment medications, they did so in an office-based setting, the report noted, and they usually got buprenorphine. This trend could be due to the canceling of the X waiver for office-based providers, a statute that made it easier for providers to become authorized to prescribe buprenorphine, OIG suggested.

OIG suggested healthcare providers need more education about buprenorphine and their own abilities to administer it among patients. In particular, learning more about the low diversion rates of buprenorphine may encourage more providers to administer it to patients, which could increase access.

The agency also suggested that the Centers for Medicare and Medicaid Services (CMS) create an action plan to address disparities in OUD medication treatment.

The report wasn’t all bad news. OIG found that Part D prescriptions for naloxone, which can reverse opioid overdoses, reached an all-time high of 600,000 in 2022. This is up from a little more than 445,000 Part D beneficiaries who received a naloxone prescription in 2021.

OIG is keeping an eye on naloxone access in the coming year, following the name-brand version of the drug, Narcan’s, approval for over-the-counter access. Narcan was the most commonly prescribed version of naloxone in 2022, OIG said, but now that it is available OTC, it is not eligible for Part D coverage.

Something similar could happen to generic versions of naloxone, as the FDA will require generic drugmakers to submit a supplement to their FDA applications that would change their status to OTC, as well.

This would mean beneficiaries would need to pay for naloxone out of pocket, which could create cost barriers down the line. In 2022, folks with the low-income subsidy paid $2 out-of-pocket for Narcan, and those without it paid $29. Moving forward, Narcan’s manufacturer indicated it will retail for $44.99, which could be cost-prohibitive.

OIG did not make recommendations for drug pricing, but it did suggest that Medicare and healthcare providers treating Medicare beneficiaries with OUD should provide patient education about the expected out-of-pocket price hike for the drug.

Other report highlights include a downswing in the number of opioid diversions and the number of patients who received high amounts of opioids from doctors or patients appearing to be “doctor shopping.” OIG also observed a consistent number of providers prescribing opioids to high-risk patients from 2021 to 2022 (98 and 101, respectively).

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