Medicare is vastly underserving older People with opioid use dysfunction, with solely 18% of enrollees with the prognosis receiving advisable remedy therapy, in line with a brand new federal oversight report.
The report, from the U.S. well being division’s Workplace of Inspector Common, additionally discovered that greater than 50,000 Half D beneficiaries overdosed on opioids in 2021, whether or not painkillers or illicit medication. That determine is an undercount, the report says, as a result of it solely tallied overdoses for which medical care was billed to Medicare. The rely, for instance, doesn’t embrace individuals who died from overdoses if there was no medical care offered.
Greater than 1.1 million Medicare beneficiaries had recognized opioid use problems in 2021, the report mentioned. There are 51 million Half D enrollees.
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The OIG has previously referred to as for the Facilities for Medicare & Medicaid Companies to enhance entry to drugs for opioid use dysfunction and reiterated that message within the report launched Thursday.
The report highlights that overdoses happen amongst older People, even when their rates of overdose deaths stay under these of different adults and haven’t spiked as sharply lately.
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The low price of remedy entry is notable as a result of insurance coverage protection could be a key impediment to getting one of many three drugs accredited to deal with opioid dependancy. The enlargement of Medicaid below the Reasonably priced Care Act, for instance, elevated entry to remedy for opioid use dysfunction, or MOUD, which is taken into account the simplest type of therapy.
However there are different obstacles as properly. One of many drugs, methadone, is just provided at particular clinics and usually needs to be taken on website every day (although the federal government has elevated the pliability of these guidelines in the course of the pandemic). As a result of methadone isn’t allotted by pharmacies, it’s not coated by Medicare Half D, the OIG’s report famous.
The 2 different drugs, naltrexone and buprenorphine, are coated by Half D. However prescribing buprenorphine requires suppliers to get a particular waiver from the federal government, limiting the variety of eligible clinicians.
The share of beneficiaries with OUD who obtain remedy elevated from 16% in 2020 to 18% in 2021, however “nonetheless, this low proportion could point out that beneficiaries have challenges accessing therapy,” the OIG report mentioned.
The brand new report did spotlight what it referred to as some enhancements. Extra beneficiaries are receiving prescriptions for the opioid overdose reversal remedy naloxone, for instance.
Opioid prescribing amongst beneficiaries has been on a downward development for a number of years, reflecting the general decline in U.S. prescribing over the previous decade. In 2021, 23% of Half D enrollees acquired an opioid prescription, down from 33% in 2016.
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