Opioid Use Disorder on the Rise Among Medicare Recipients

Skyrocketing opioid overdose deaths since 2019 have impacted nearly every state in the country, and the inescapable prevalence of fentanyl, a potent synthetic opioid, threatens to escalate the grim circumstances further. Although awareness of the ongoing opioid epidemic in the U.S has ramped up most recently, there’s a segment of the population that’s mainly suffering in silence.

A recent study found that over 1 million Medicare beneficiaries were diagnosed with opioid use disorder
(OUD) in 2021. Findings by the Office of Inspector General for the U.S. Department of Health and Human Services (HHS-OIG) also show that more than 50,000 Medicare part D beneficiaries experienced an opioid overdose last year. This count only shows the number of enrollees who received overdose care billed to Medicaid, those who died from overdose are not tallied into the overall figure. 

Who is Most Impacted?

Most Medicare recipients are over the age of 65, although there are many younger people with disabilities and certain health conditions that also rely on the service. The study also found that despite the rate of OUD diagnosis among Medicare users, only one in five received treatment through medication and counseling services, also known as MAT (medication-assisted treatment). 

With only 18% of enrollees diagnosed with OUD receiving life-saving addiction healthcare, the OIG continues to call for the Centers for Medicare & Medicaid Services to extend access to FDA-approved medications that have been proven to assist those with opioid use disorder. Most of the people struggling are elderly Medicare recipients, even though their overdose rate is lower than their younger counterparts.

Barriers to Treatment

Medications used to treat opioid use disorder have varying Medicare coverage, proving to be an obstacle for many who need help. While the Affordable Care Act helped expand Medicaid access to these addiction treatments, the nature of the therapies themselves prove to be yet another obstacle.

Methadone, for example, is one of the oldest treatments for OUD and has saved countless lives over the past five decades. However, it’s considered a schedule II drug and needs to be taken daily under medical supervision, which includes daily trips to a dispensing clinic. Because pharmacies do not dispense methadone, it’s not covered by Medicare part D, putting it out of reach for many in need.

Other MAT medications that can be dispensed by pharmacies, like naltrexone and buprenorphine, are covered by Part D Medicare but require a governmental waiver for eligible dispensing clinicians, which creates a very small pool of availability.

Although the percentage of Medicare beneficiaries diagnosed with OUD who receive MAT has increased from 16% to 18% from 2010 to 2021, it’s still a tiny margin compared to how many are diagnosed and will likely struggle with chronic illness or addiction without medical help.

Middlesex Recovery provides private, effective outpatient addiction treatment in an office-based setting with specialized medical staff. While each patient’s needs are unique, Middlesex Recovery is in-network with many insurance plans, including Medicare. The team at each office knows that dealing with confusing insurance paperwork can be a pain, so administrative intake coordinators have streamlined the process to make it easier. To learn more about the programs available, message or call the nearest Middlesex Recovery location today and take the first step towards better health.