Year: 2025
Type: article
Abstract: Americans over age 65 and eligible for Medicare represent an increasing share of those diagnosed with opioid use disorder (OUD),1 with over 1 million Medicare beneficiaries diagnosed with OUD in 2021 alone.2 The Food and Drug Administration has approved buprenorphine, methadone, and naltrexone for the treatment of OUD (MOUD), medications considered the gold-standard for OUD treatment.3 Despite MOUD's benefits, MOUD treatment rates remain stubbornly low.2 Beginning in 2020, the Medicare Program has covered methadone for OUD treatment at opioid treatment programs (OTPs) as part of a new Part B benefit.4 While previous work has found increasing methadone dispensing rates after this policy change,5,6 it is also important to understand how the change affected those most likely to benefit from increased access to MOUD. We assess how MOUD receipt changed before and after the 2020 methadone policy among fee-for-service (FFS) Medicare beneficiaries diagnosed with OUD. Given geographic disparities in access to MOUD,7,8 we also examine whether the policy change is associated with changes in MOUD receipt based on beneficiary residence in an urban vs rural county. We accessed 2018 through 2020 Medicare FFS claims data and Part D prescription drug event data for beneficiaries enrolled in FFS Medicare and Part D. We used Medicare Part B carrier files to identify beneficiaries with a diagnosis of OUD in any of 4 rolling quarters beginning in Q2 of 2018 and constructed measures of MOUD receipt using MOUD claims in the last quarter. We used the National Center for Health Statistics definition to categorize beneficiaries as urban or rural county residents.9 We used CMS-defined Health Care Common Procedural Coding System codes for receipt of OTP-provided services in the Part B carrier claims to identify MOUD dispensed at an OTP. We used National Drug Codes to identify outpatient prescriptions covered by Part D for buprenorphine and naltrexone dispensed at retail pharmacies. Please see the Supplementary materials for more detail. We calculated the percentage of Medicare FFS beneficiaries with an OUD diagnosis receiving methadone, buprenorphine, or naltrexone, as well as receiving any MOUD in each quarter of both 2019 and 2020. Standard errors for proportions and differences in proportions were calculated using standard formula for binomial distributions; due to large sample sizes, there was very little variability in estimates, and all comparisons are statistically significant. The study was determined to be exempt with a waiver of consent by RAND's Institutional Review Board. All analyses were completed using R 4.3.0 (R Core Team 2023).10 Each quarter of 2019 and 2020 had more than 425 000 FFS Medicare beneficiaries with a recent OUD diagnosis enrolled in Part D. Overall rates of beneficiary receipt of any MOUD increased from 12.1% in Q1 2019% to 20.4% in Q4 2020. MOUD rates for rural county beneficiaries were about 0.5% to 2.5% points higher than MOUD rates for urban county beneficiaries (Figure 1), with 13.2% of rural county beneficiaries receiving any MOUD in Q1 2019, increasing to 21.1% in Q4 2020, compared to 11.5% rising to 20.2% in urban county beneficiaries. Percent of Medicare beneficiaries with recent OUD diagnosis who received any MOUD, 2019 and 2020. The Medicare Part B carrier files were used to identify beneficiaries with a diagnosis of OUD in any of the 3 quarters preceding the quarter of interest, as well as the quarter of interest. Recent diagnosis is defined as beneficiaries with any diagnosis of OUD in any of these 4 quarters. Vertical line is for the start of 2020 when the new Medicare policy change covering methadone for the treatment of OUD went into effect. Changes depicted should be interpreted in the context of the y-axis, which extends from 10% to 22.5%. After the 2020 Medicare policy change, there was a higher rate of methadone dispensing for urban county beneficiaries compared to rural county beneficiaries (4.9% urban compared to 2.5% rural in Q1 2020), with modestly increasing rates of dispensing in both urban and rural counties throughout 2020. Buprenorphine dispensing rates were substantially higher than methadone rates for both rural and urban county beneficiaries across all quarters, ranging from 1.8% to 4.3% points higher among rural county beneficiaries than urban beneficiaries. We find increased receipt of methadone among Medicare beneficiaries enrolled in Part D after Medicare implemented new coverage for methadone as part of OUD treatment in 2020. The increase in methadone receipt after the policy change is encouraging, suggesting Medicare beneficiaries gained access to an important MOUD treatment option and narrowing the gap between MOUD receipt rates for urban vs rural residents with OUD. However, rates of MOUD receipt for Medicare beneficiaries with OUD overall remain low, with only about 20% of beneficiaries diagnosed with OUD receiving any MOUD in Q4 2020. Compared to methadone-focused policies, efforts to expand buprenorphine access may have greater impact in reaching Medicare beneficiaries with OUD across both urban and rural counties. Further research assessing the effects of the May 2023 end of the COVID-19 national Public Health Emergency, which relaxed MOUD access rules, and the separate removal of the buprenorphine waiver requirement for providers, may yield important new insights into how policy shaped MOUD access. Dr. Taylor had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Support was provided by the National Institute of Aging (1R21AG071925-01A1, Drs. Cantor and Taylor). The funding sources had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; and preparation, review, or decision to submit the manuscript. Supplementary material is available at Health Affairs Scholar online. No financial disclosures were reported by the authors of this paper.
Source: Health Affairs Scholar
Language: English
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $3,150
Funder: Ministry of Urban Development
OpenAlex ID: W4411669376