Report: Too Few Beneficiaries Receiving Needed Opioid Treatment Through Medicare

A recent report from the U.S. Department of Health and Human Services Office of Inspector General (OIG) shows that many people with Medicare are not receiving needed prescription medications and therapy to treat their Opioid Use Disorder (OUD). These findings come during a surge in opioid-related overdose deaths nationally.

Around one million people with Medicare had a diagnosed OUD in 2020. OIG defines an OUD as “a problematic pattern of opioid use that leads to clinically significant impairment or distress and is sometimes referred to as opioid addiction. It is a chronic disease that may cause people to seek opioids compulsively or in ways that they find difficult to control despite harmful consequences.” Despite the prevalence, only 16% of beneficiaries with OUDs received recommended medication to treat their opioid use disorder. These medications work to decrease illicit opioid use and opioid-related overdose deaths.

Of the 16% who received medication for OUD, only half received the recommended behavioral therapy that should accompany that treatment.

As with many coverage issues, there is an equity component to this missing OUD treatment. Beneficiaries who are older, Asian and Pacific Islander, Hispanic, or Black were less likely to receive medication than younger or white beneficiaries.

These data show continuing issues in coverage for OUD and other substance use disorders through Medicare. Limited numbers of providers, coupled with gaps in coverage, lead to missing treatment for a significant portion of people with OUDs and Medicare.

OIG recommends that the Biden Administration do more to ensure appropriate OUD treatment for beneficiaries, including through outreach to beneficiaries, increasing the number of providers for OUD, improving utilization of behavioral therapy, and better data collection to track issues.

At Medicare Rights, we concur with these recommendations and urge the Biden Administration and Congress to do more to increase OUD treatment options for all beneficiaries.

Read the OIG report.

Read more about substance use coverage in Medicare.