A new study shows that after Medicare expanded coverage for methadone, use for patients with opioid use disorder spiked, with much of the increase among Medicare Advantage enrollees under age 65, particularly among dual eligibles.
The expanded coverage comes amid heavy health consequences from the opioid crisis, with an estimated 80,411 overdose deaths in the US in 2021.1 Methadone is a highly effective treatment but is a Schedule II opioid and is only given to patients in federally certified and licensed opioid treatment programs.
Medicare began covering methadone for the treatment of OUD in January 2020 under a bundled payment reimbursement policy. Additional Medicare and Substance Abuse and Mental Health Services Administration policy changes adopted in March 2020 because of the COVID-19 pandemic eased access as well.1
To examine the effects of these changes, the researchers looked at encounter data and pharmacy records for almost 10 million MA members, finding increasing rates of methadone use each quarter, starting in January 2020 with the expanded coverage.2 They found that methadone use did not replace use of other opioid treatments, including buprenorphine, which also saw increased use among MA members during the study period.2
The researchers noted the importance of increasing access to effective OUD treatments, saying the results suggest the policy changes may have eased access to medications for OUD for Medicare beneficiaries during the pandemic, particularly for dual eligibles, which make up between 22% and 26% of all MA enrollees younger than 65 years.1
Increased use of methadone for OUD can be beneficial for both plans and members. A separate study found Medicare beneficiaries with OUD but no MOUD saw costs of $12.1 billion more than those with OUD and MOUD.3 It also found Medicare spending on comorbidities linked to OUD was $3 billion for medical comorbidities and $1.7 billion for mental health comorbidities, highlighting the importance of mental health care for this population.
“Expanding Medicare coverage of appropriate levels of care could improve access to effective treatment and reduce the costs associated with untreated OUD,” the authors of that study said, adding it would “likely result in substantial Medicare cost savings.”
Going forward, the authors of the recent study on methadone coverage recommend more research to establish whether the usage changes represent an increase in overall OUD treatment, and to determine the effects of policy and coverage changes on clinical outcomes for Medicare beneficiaries.1
Additional research is also expected from the Government Accountability Office, which is required by the Consolidated Appropriations Act, 2023 to conduct a study comparing MA’s mental health and substance use disorder benefits with traditional Medicare and with other benefits offered by MA plans, with results set for 2025.4
As the opioid crisis continues and MA enrollment rises, ensuring these members have access to affordable mental health and MOUD should be of high importance for plans that want to help all members live their healthiest lives.
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References
- Taylor, E., Cantor, J., Bradfor, A., et al. Trends in methadone dispensing for opioid use disorder after Medicare payment policy changes. JAMA Network Open. May 19, 2023. https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2805031
- Murez, C. Medicare’s coverage of methadone could help people get off opioids. Billings Gazette. May 22, 2023. https://billingsgazette.com/lifestyles/health-med-fit/medicares-coverage-of-methadone-could-help-get-people-off-opioids/article_2ba02e7a-5007-5dac-a7e2-6e995a9eb719.html
- Mark, T., Parish, W., Weber, E. et al. The cost of opioid use disorder-related conditions in Medicare. Drug and Alcohol Dependence. March 1, 2023. https://pubmed.ncbi.nlm.nih.gov/36701935/
- Freed, M., Sroczynski, N., Neuman, T. Mental health and substance use disorder coverage in Medicare Advantage plans. KFF. April 28, 2023. https://www.kff.org/medicare/issue-brief/mental-health-and-substance-use-disorder-coverage-in-medicare-advantage-plans/
