Trends in Buprenorphine and Methadone Dispensing Among Medicare Advantage and Commercial Enrollees, 2019-2024

Despite the existence of effective medications for opioid use disorder, including methadone and buprenorphine, overdose deaths remain high. In 2020, Medicare began covering methadone for the treatment of opioid use disorder; separate federal policy changes expanded medications for opioid use disorder access through telemedicine in response to the COVID-19 pandemic. However, little is known about national trends in methadone and buprenorphine dispensing across commercial and Medicare Advantage payers, especially by patient characteristics.

A retrospective repeated cross-sectional study was conducted using 2019-2024 data from Optum's deidentified Clinformatics Data Mart Database to examine quarterly methadone and buprenorphine dispensing rates per 100,000 enrollees diagnosed with opioid use disorder. Rates were stratified by insurance type (commercial versus Medicare Advantage), age, and dual eligibility status. Joinpoint regression identified statistically supported trend inflection points and annual percentage changes per segment.

Among opioid use disorder-diagnosed enrollees, Medicare Advantage methadone rates rose from 624 to 5,462 per 100,000 between 2020 Quarter 1 and 2024 Quarter 2 (average annual percentage change of +104.6% per year), whereas commercial methadone rates increased from 3,552 to 6,821 per 100,000 (average annual percentage change of +23.9% per year) during the same period. Medicare Advantage buprenorphine rates increased steadily (average annual percentage change of +20.7% per year), whereas commercial buprenorphine rates peaked in 2022 and declined at -20.0% per year after 2023 Quarter 2. Dually eligible Medicare Advantage enrollees aged <65 years had the highest medications for opioid use disorder dispensing rates throughout.

Methadone dispensing increased substantially among Medicare Advantage enrollees with opioid use disorder after 2020, particularly among dually eligible beneficiaries aged <65 years. The decline in commercial buprenorphine dispensing after 2022 warrants further investigation. Tailored efforts may be needed to close payer-related treatment gaps and support broader medications for opioid use disorder access.