Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts.
Department of Health Policy and Management, University of Pittsburgh School of Public Health, Pittsburgh, Pennsylvania.
JAMA Health Forum. 2024 Jul 5;5(7):e241907. doi: 10.1001/jamahealthforum.2024.1907.
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.
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.
Receiving MOUD care in an OTP.
Comparisons of 2022 beneficiaries treated in OTPs vs other non-OTP settings in 2022.
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.
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.
2020 年 1 月，医疗保险开始为在提供美沙酮和其他药物滥用障碍治疗（MOUD）的阿片类药物治疗计划（OTP）中使用药物治疗阿片类药物使用障碍（MOUD）的患者支付费用。几乎没有研究描述对这一支付变化的反应，以及它是否导致更多的患者接受 MOUD 治疗，还是只是改变了谁来支付这种护理费用。
描述有多少和哪些医疗保险受益人接受 OTP 的护理，以及与其他环境中接受 MOUD 治疗的患者相比如何。
设计、地点和参与者：本横断面研究包括在 2019-2022 年期间，100%的美国医疗保险 B 部分和 D 部分索赔中确定的所有接受 MOUD 护理的患者。在 2019-2020 年转化后的医疗补助统计信息系统中，与医疗保险和医疗补助双重保险的同时在 OTP 中接受护理的患者也被包括在内。
在 OTP 中接受 MOUD 治疗。
2022 年接受 OTP 治疗的受益人与 2022 年其他非 OTP 环境下接受治疗的受益人的比较。
从 2020 年 1 月每 10000 人中有 4 人（14160 名受益人）接受 OTP 治疗，到 2020 年 8 月每 10000 人中有 7 人（25596 名受益人），再到 2022 年 12 月达到稳定水平；在 2022 年接受 OTP 治疗的 38870 名患者（23%≥66 岁；35%为女性）中，96%接受美沙酮治疗。与在其他环境中接受 MOUD 治疗的患者相比，在 OTP 接受治疗的患者更可能是 65 岁及以下（65% vs 62%；P<0.001），不太可能是白人（72% vs 82%；P<0.001），更可能是城市居民（86% vs 74%；P<0.001）。当医疗保险 OTP 覆盖范围开始时，与医疗保险和医疗补助双重保险的有 OTP 索赔的患者人数并没有相应减少。在 1854 个 OTP 中，有 1115 个（60%）在 2022 年向医疗保险收费，各州的医疗保险收费比例从 13%到 100%不等。
本研究表明，自 2020 年医疗保险 OTP 覆盖范围开始以来，接受 OTP 服务治疗 MOUD 的医疗保险受益人的数量迅速增加，大多数 OTP 已开始向医疗保险收费。与接受其他形式的 MOUD 治疗的患者相比，在 OTP 接受治疗的患者更可能是城市居民和少数族裔群体的成员。
