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. 2024 Jul 5;5(7):e241907.
doi: 10.1001/jamahealthforum.2024.1907.

Medicare Payment for Opioid Treatment Programs

Carter H Nakamoto  1 , Haiden A Huskamp  1 , Julie M Donohue  2 , Michael L Barnett  3 , Adam J Gordon  4   5 , Ateev Mehrotra  1
Affiliations

Medicare Payment for Opioid Treatment Programs

Carter H Nakamoto et al. JAMA Health Forum. .

Abstract

Importance: Medicare began paying for medications for opioid use disorder (MOUD) at opioid treatment programs (OTPs) that dispense methadone and other MOUD in January 2020. There has been little research describing the response to this payment change and whether it resulted in more patients receiving MOUD or just a shift in who pays for this care.

Objective: To describe how many and which Medicare beneficiaries receive care from OTPs and how this compares to those receiving MOUD in other settings.

Design, setting, and participants: This cross-sectional study included all patients receiving MOUD care identified in 2019-2022 100% US Medicare Parts B and D claims. Patients receiving care in an OTP who were dually insured with Medicare and Medicaid in the 2019-2020 Transformed Medicaid Statistical Information System were also included.

Exposure: Receiving MOUD care in an OTP.

Main outcomes and measures: Comparisons of 2022 beneficiaries treated in OTPs vs other non-OTP settings in 2022.

Results: The share of Medicare beneficiaries treated by OTPs rose steadily from 4 per 10 000 (14 160 beneficiaries) in January 2020 to 7 per 10 000 (25 596 beneficiaries) in August 2020, then plateaued through December 2022; of 38 870 patients (23% ≥66 years; 35% female) treated at an OTP in 2022, 96% received methadone. Patients in OTPs, compared to those receiving MOUD in other settings, were more likely be 65 years and younger (65% vs 62%; P < .001), less likely to be White (72% vs 82%; P < .001), and more likely to be an urban resident (86% vs 74%; P < .001). When Medicare OTP coverage began, there was no associated drop in the number of dually insured patients with Medicaid with an OTP claim. Of the 1854 OTPs, 1115 (60%) billed Medicare in 2022, with the share billing Medicare ranging from 13% to 100% across states.

Conclusions and relevance: This study showed that since the initiation of Medicare OTP coverage in 2020, there has been a rapid increase in the number of Medicare beneficiaries with claims for OTP services for MOUD, and most OTPs have begun billing Medicare. Patients in OTPs were more likely to be urban residents and members of racial or ethnic minority groups than the patients receiving other forms of MOUD.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Huskamp reported grants from the National Institute on Drug Abuse outside the submitted work. Prof Barnett reported serving as an expert witness in litigation against opioid manufacturers and distributors. Dr Gordon reported grants from the National Institutes of Health and the US Department of Veterans Affairs during the conduct of the study; personal fees from UpToDate outside the submitted work; and serving on the board of directors for the American Society of Addiction Medicine, the Association for Multidisciplinary Education and Research in Substance Use and Addiction, and the International Society of Addiction Journal Editors. No other disclosures were reported.

Figures

Figure 1.
Figure 1.. Trends in Opioid Treatment Program (OTP) Billing in Fee-for-Service Medicare, 2020-2022
Other includes naltrexone and unspecified medications for the treatment of opioid use disorder.
Figure 2.
Figure 2.. Medicare Beneficiaries Receiving Any Form of Medication for Opioid Use Disorder at Opioid Treatment Programs (OTPs) or Other Outpatient Settings
Figure 3.
Figure 3.. Patients Dually Insured by Medicare and Medicaid With Opioid Treatment Program (OTP) Care Paid for Via Medicaid
See this image and copyright information in PMC

References

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    1. Many Medicare beneficiaries are not receiving medication to treat their opioid use disorder. US Department of Health and Human Services . December 15, 2021. Accessed June 17, 2024. https://oig.hhs.gov/oei/reports/OEI-02-20-00390.asp