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Medicare is vastly underserving older Americans with opioid use disorder, with only 18% of enrollees with the diagnosis receiving recommended medication treatment, according to a new federal oversight report.

The report, from the U.S. health department’s Office of Inspector General, also found that more than 50,000 Part D beneficiaries overdosed on opioids in 2021, whether painkillers or illicit drugs. That figure is an undercount, the report says, because it only tallied overdoses for which medical care was billed to Medicare. The count, for example, doesn’t include people who died from overdoses if there was no medical care provided.

More than 1.1 million Medicare beneficiaries had diagnosed opioid use disorders in 2021, the report said. There are 51 million Part D enrollees.

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The OIG has previously called for the Centers for Medicare & Medicaid Services to improve access to medications for opioid use disorder and reiterated that message in the report released Thursday.

The report highlights that overdoses occur among older Americans, even if their rates of overdose deaths remain below those of other adults and haven’t spiked as sharply in recent years.

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The low rate of medication access is notable because insurance coverage can be a key obstacle to getting one of the three medications approved to treat opioid addiction. The expansion of Medicaid under the Affordable Care Act, for example, increased access to medication for opioid use disorder, or MOUD, which is considered the most effective form of treatment.

But there are other barriers as well. One of the medications, methadone, is only offered at special clinics and typically has to be taken on site each day (though the government has increased the flexibility of those rules during the pandemic). Because methadone is not dispensed by pharmacies, it is not covered by Medicare Part D, the OIG’s report noted.

The two other medications, naltrexone and buprenorphine, are covered by Part D. But prescribing buprenorphine requires providers to get a special waiver from the government, limiting the number of eligible clinicians.

The percentage of beneficiaries with OUD who receive medication increased from 16% in 2020 to 18% in 2021, but “nonetheless, this low proportion may indicate that beneficiaries have challenges accessing treatment,” the OIG report said.

The new report did highlight what it called some improvements. More beneficiaries are receiving prescriptions for the opioid overdose reversal medication naloxone, for example.

Opioid prescribing among beneficiaries has been on a downward trend for several years, reflecting the overall decline in U.S. prescribing over the past decade. In 2021, 23% of Part D enrollees received an opioid prescription, down from 33% in 2016.

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