Use of Opioid Agonist Therapy for Medicare Patients in 2013

Despite public policy efforts to prevent opioid overdose and addiction, opioid overdose rates reached record high numbers in 2014. 1 The population that uses Medicare, the federal insurance program for Americans who have certain disabilities or are 65 years or older, has among the highest and most rapidly growing prevalence of opioid use disorder, with more than 6 of every 1000 patients (more than 300 000 of 55 million) diagnosed 2 and with hospitalizations increasing 10% per year. 3Data on patients with commercial insurance plans (the other likely source for national population data) show just more than 1 of every 1000 patients diagnosed. 2Prevention initiatives are essential for reducing the number of new patients with opioid use disorder, but treatment will be required for those already addicted to opioids.Opioid agonist therapy (OAT), including buprenorphine-naloxone (Suboxone) and methadone, is the most effective pharmacotherapy for opioid addiction. 4 An analysis of Medicare data on buprenorphine-naloxone prescribing allows us to make inferences on prescribers' use of this treatment.Medicare Part D (prescription drug coverage) does not pay for methadone maintenance treatment for opioid addiction.Hence, buprenorphine-naloxone (or buprenorphine alone, in the case of pregnancy) is the only covered OAT option for patients with opioid use disorder.We hypothesized that the rates of buprenorphine-naloxone prescribing would be below the projected need.