Medicare Payment for Opioid Treatment Programs.

Area of Science:

• Health Services Research
• Substance Use Disorder Treatment
• Health Policy

Background:

• Medicare initiated coverage for medications for opioid use disorder (MOUD) at opioid treatment programs (OTPs) in January 2020.
• The impact of this policy change on patient access and care settings for MOUD remained under-researched.

Purpose of the Study:

• To quantify Medicare beneficiaries receiving MOUD care in OTPs.
• To compare characteristics of patients in OTPs versus other MOUD treatment settings.
• To assess the adoption of Medicare billing by OTPs.

Main Methods:

• Cross-sectional analysis of 2019-2022 US Medicare Parts B and D claims.
• Inclusion of dually insured Medicare-Medicaid patients from the Transformed Medicaid Statistical Information System (2019-2020).
• Comparison of patient demographics and treatment settings in 2022.

Main Results:

• The proportion of Medicare beneficiaries treated in OTPs increased from 4 to 7 per 10,000 between January and August 2020, then plateaued.
• In 2022, 60% of OTPs billed Medicare, with significant state-level variation.
• Patients in OTPs were younger, less likely to be White, and more likely to reside in urban areas compared to those receiving MOUD elsewhere.

Conclusions:

• Medicare coverage for MOUD at OTPs has led to a substantial rise in beneficiary utilization of these services.
• Most OTPs have adopted Medicare billing, indicating policy effectiveness.
• OTP patients represent a distinct demographic, often from urban areas and minority groups, highlighting the role of OTPs in serving specific populations.