Access to Medication Treatment for Opioid Use Disorder in Fee-for-Service Medicare

Americans over age 65 and eligible for Medicare represent an increasing share of those diagnosed with opioid use disorder (OUD), with over one million Medicare beneficiaries diagnosed with OUD in 2021 alone. The Food and Drug Administration has approved buprenorphine, methadone and naltrexone for the treatment of OUD (MOUD), medications considered the gold-standard for OUD treatment. Despite MOUD’s benefits, MOUD treatment rates remain stubbornly low. Beginning in 2020, the Medicare Program has covered methadone for OUD treatment at opioid treatment programs (OTPs) as part of a new Part B benefit. While previous work has found increasing methadone dispensing rates after this policy change, it is also important to understand how the change affected those most likely to benefit from increased access to MOUD. We assess how MOUD receipt changed before and after the 2020 methadone policy among fee-for-service (FFS) Medicare beneficiaries diagnosed with OUD. Given geographic disparities in access to MOUD, we also examine whether the policy change is associated with changes in MOUD receipt based on beneficiary residence in an urban versus rural county.