In mid-December 2021, the United States Department of Health and Human Services Office of Inspector General (HHS OIG) released a data brief that found many Medicare beneficiaries are not receiving medication to treat their opioid use disorder.
Currently, three different medications are approved for the treatment of opioid use disorder: buprenorphine, methadone, and naltrexone. Beneficiaries can receive these drugs in either office-based settings or from opioid treatment programs. To prescribe or administer buprenorphine in office-based settings, providers must receive a waiver through the Substance Abuse and Mental Health Services Administration (SAMHSA). Methadone can only be administered and dispensed in an outpatient setting in opioid treatment programs.
In the data brief, HHS OIG states that more than 1 million Medicare beneficiaries were diagnosed with opioid use disorder in 2020 and that while opioid use disorder can be treated with medication, only 16% of those beneficiaries received medication to treat their disorder. HHS OIG found that even less (less than half) received both medication and behavioral therapy to treat their opioid use disorder.
Further, the type of treatment beneficiaries received seemed to depend on which state they live in. Beneficiaries in Florida, Texas, Kansas, and Nevada were two to three times less likely to receive medication to treat their opioid use disorder. Additionally, Asian/Pacific Islander, Hispanic, and Black beneficiaries were less likely to receive medication than White beneficiaries. Older beneficiaries and those who did not receive the Part D low-income subsidy were also less likely to receive medication to treat their opioid use disorder.
OIG analyzed claims from Medicare Parts B, C, and D to understand the extent to which beneficiaries diagnosed with opioid use disorder received medication and/or behavioral therapy to treat it through Medicare in 2020.
In conclusion, HHS OIG recommended that the Centers for Medicare and Medicaid Services (CMS) make six changes, four of which CMS agreed with and the other two it did not explicitly state agreement or disagreement with.
HHS OIG recommended that CMS conduct additional outreach to beneficiaries to increase awareness about coverage for the treatment of opioid use disorder. CMS concurred, noting that it has previously conducted “extensive outreach” to beneficiaries on the topic and will continue to do so, as appropriate. CMS also noted that it has updated its website and its Medicare & You Handbook.
HHS OIG also recommended that CMS take steps to increase the number of providers and opioid treatment programs for Medicare beneficiaries with opioid use disorder. CMS concurred, noting prior “extensive outreach” to providers and opioid treatment programs about opportunities to treat Medicare beneficiaries with opioid use disorder. CMS also said it would continue to monitor payment mechanisms and rates for office-based treatment to assess their efficacy.
HHS OIG recommended CMS collect data on the use of telehealth in opioid treatment programs, which CMS agreed with, noting that it had finalized coding changes in the CY 2022 Physician Fee Schedule that would allow it to collect data to monitor the use of telehealth in opioid treatment programs. HHS OIG also recommended CMS collect information on counseling and therapy sessions delivered via telehealth included in weekly bundled payments.
CMS also concurred with the HHS OIG recommendation to create an action plan and take steps to address disparities in the treatment of opioid use disorder. CMS noted that it has been working to identify and track drivers of disparities in the treatment of opioid use disorder. CMS also said it will use its existing equity framework to further analyze and develop opioid use disorder plans to address disparities in the treatment of opioid use disorder, amending them as needed.
When it comes to the recommendations that CMS did not make explicit agreement or disagreement on, HHS OIG recommended that the agency assist SAMHSA by providing data about the number of Medicare beneficiaries receiving buprenorphine in office-based settings and the geographic areas where Medicare beneficiaries remain underserved. However, in its response, CMS did state that it regularly works with SAMHSA and will provide data when requested to do so.
CMS also did not explicitly indicate whether it concurred with the HHS OIG recommendation to take steps to increase the utilization of behavioral therapy among beneficiaries receiving medication to treat opioid use disorder. CMS noted that it has previously undertaken extensive outreach to beneficiaries to describe the benefits available to them for the treatment of opioid use disorder. It also stated that it will continue outreach to both providers and beneficiaries to ensure awareness of all Medicare-covered services and options.
