Rates of Opioid Agonist Therapy Prescriptions for Medicare Patients Reflect Treatment Gap

Medicare patients comprise a segment of the population that is particularly affected by opioid use disorder, with rates of related hospitalization growing by 10% annually.¹ While the number of commercial insurance patients estimated to have a diagnosed opioid use disorder is just over 1 per 1000 patients, more than 6 of every 1000 Medicare patients have been diagnosed.²

Although prevention efforts are important, treatment for patients who have already developed addiction is also needed. Buprenorphine-naloxone–or buprenorphine alone for pregnant patients–is the only type of opioid agonist therapy (OAT) that is covered by Medicare Part D for the treatment of opioid use disorder.

In a new study reported in JAMA Psychiatry, researchers at Stanford University School of Medicine in Stanford, California, examined 2013 Medicare claims data to compare prescription rates of this OAT with prescription rates of Schedule II opioid pain medications.³

They analyzed 1 188 393 892 claims worth $80 941 763 731 from Medicare Part D, which covers an estimated 68% of Medicare patients. For each prescriber, the records included data on drug prescribed and total number of claims and costs, as well as provider location and specialty. The results were as follows:

• Less than 2% of physicians responsible for 56 516 854 opioid prescriptions also prescribed buprenorphine-naloxone.
• Only 0.025% of PCPs who prescribed opioids also prescribed buprenorphine (71 718 vs 1793).
• Pain physicians averaged thousands of opioid prescriptions vs <5 buprenorphine-naloxone prescriptions in most cases.
• Addiction specialist physicians (only 100 affiliated with Medicare) had the highest number of buprenorphine-naloxone prescriptions, with 98.8 claims per year.
• The number of claims for other specialties for buprenorphine-naloxone vs Schedule II opioids, respectively were: family medicine, 7.4 vs 161.1; interventional pain management, 4.7 vs 1124.9; anesthesiology, 3.1 vs 481.2; and numerous other specialties in descending order.
• Claims ratios were more than 300 times the national average in 6 states: Vermont, Maine, Massachusetts, Rhode Island, District of Columbia, and New Hampshire.

Though these findings cannot fully capture physician or patient factors, the authors say they illuminate a major treatment gap: While approximately 300 000 Medicare patients have an opioid use disorder, only an estimated 81 000 Medicare patients have been prescribed OAT.

To support efforts to curb opioid addiction, OAT should be promoted by physicians of various specialties. “Physicians who prescribe high volumes of opioids and thus already have an established therapeutic alliance and prior experience with opioid prescribing are especially well-situated, with some additional training, to intervene when cases of prescription opioid misuse, overuse, and use disorders arise,” note the authors.

References

1. Owens PL, Barrett ML, Weiss AJ, Washington RE, Kronick R. Hospital inpatient utilization related to opioid overuse among adults, 1993–2012: statistical brief #177. Healthcare Cost and Utilization Project (HCUP) Statistical Briefs. Rockville (MD): Agency for Healthcare Research and Quality (US); 2006-2014. 
2. Dufour R, Joshi AV, Pasquale MK, et al. The prevalence of diagnosed opioid abuse in commercial and Medicare managed care populations. Pain Pract. 2014; 14(3):E106-E115.
3. Lembke A, Chen JH. Use opioid agonist therapy for medicare patients in 2013. JAMA Psychiatry. 2016; doi:10.1001/jamapsychiatry.2016.1390.