Help Is on the Way: Medicare Coverage of Opioid Treatment Programs

Abstract

Opioid use disorder (OUD) among older adults has been increasing, yet evidence still remains scarce for age‐specific treatment. We discuss the three US Food and Drug Administration–approved medications used to treat OUD (methadone, buprenorphine, and naltrexone) and consider evidence gaps in OUD treatment in older adults. Legislation passed in 2018 (the Substance Use Disorder Prevention That Promotes Opioid Recovery and Treatment for Patients and Communities Act [also known as the SUPPORT Act]) expanded Medicare coverage to include bundled payment for OUD treatment through opioid treatment programs, permitting coverage of methadone treatment for the first time. Since the policy change will take effect in January 2020, healthcare providers need to be aware of new opportunities for treatment when caring for older adult patients with OUD. J Am Geriatr Soc 68:637–640, 2020

Misalignment of Stakeholder Incentives in the Opioid Crisis

“…Expanding capacity of treatments and providers: Adequate monetary incentives and reimbursement for providers, reducing regulatory burdens, providers’ education, private insurance coverage, and utilizing state subsidies are reported to impact the successful recruitment of providers [ 89 , 90 , 91 ]. Real-world instances of initiatives include the Substance Abuse and Mental Health Services Administration and Health Resources and Services Administration (SAMHSA-HRSA) joint project on expanding the use of medications in safety-net settings [ 92 ], SAMHSA’s Addiction Technology Transfer Center Network [ 93 ], CVS Pharmacy providing naloxone without prescriptions in most states [ 94 ], California implementing a state-wide hub-and-spoke model to improve access to OUD treatments [ 95 ], improving the rate of follow-up treatments among Medicaid enrollees in Pennsylvania by offering incentives to providers [ 96 ], and the SUPPORTAct expanding Medicare coverage to include bundled payment for treatments [ 97 ]. By contrast, in the first three year implementation of Global Payment and Accountable Care by Blue Cross Blue Shield of Massachusetts, no significant impact on using treatments was observed [ 98 ].…”

Insurance Coverage and Provision of Opioid Treatment: Evidence from Medicare

“…Advantage plans as of January 2020 (Congressional Research Service, 2020). This change was expected by addiction treatment experts to fundamentally reshape the landscape for OUD−related methadone care within Medicare (Felix et al, 2020).…”

Measurement Approaches to Estimating Methadone Continuity in Opioid Use Disorder Care

“…19 Commercial insurers also have often implemented exclusions or benefit design limits, 20 and Medicare until recently did not cover MOUD care. 21 In recent years, insurance restrictions have eased, 15,22,23 including among commercial insurers 20 and in Medicare and Medicaid programs through the SUPPORT [Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment (SUPPORT) for Patients and Communities] Act. 23 In light of eased insurance restrictions, methadone use is increasing.…”

“…In addition, although public sources, in the form of state federal block grants and Medicaid programs, have figured prominently in methadone financing,16 historically many state Medicaid programs limited methadone coverage,16–18 a barrier not entirely remedied by block grants 19. Commercial insurers also have often implemented exclusions or benefit design limits,20 and Medicare until recently did not cover MOUD care 21. In recent years, insurance restrictions have eased,15,22,23 including among commercial insurers20 and in Medicare and Medicaid programs through the SUPPORT [Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment (SUPPORT) for Patients and Communities] Act 23.…”