PMID- 37204793 OWN - NLM STAT- MEDLINE DCOM- 20231217 LR - 20231217 IS - 2574-3805 (Electronic) IS - 2574-3805 (Linking) VI - 6 IP - 5 DP - 2023 May 1 TI - Trends in Methadone Dispensing for Opioid Use Disorder After Medicare Payment Policy Changes. PG - e2314328 LID - 10.1001/jamanetworkopen.2023.14328 [doi] LID - e2314328 AB - IMPORTANCE: A significant proportion of Medicare beneficiaries have a diagnosed opioid use disorder (OUD). Methadone and buprenorphine are both effective medications for the treatment of OUD (MOUDs); however, Medicare did not cover methadone until 2020. OBJECTIVE: To examine trends in methadone and buprenorphine dispensing among Medicare Advantage (MA) enrollees after 2 policy changes in 2020 related to methadone access. DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional analysis of temporal trends in methadone and buprenorphine treatment dispensing assessed MA beneficiary claims from January 1, 2019, through March 31, 2022, captured by Optum's Clinformatics Data Mart. Of 9 870 791 MA enrollees included in the database, 39 252 had at least 1 claim for methadone, buprenorphine, or both during the study period. All available MA enrollees were included. Subanalyses by age and dual eligibility for Medicare and Medicaid status were conducted. EXPOSURES: Study exposures were (1) the Centers for Medicare & Medicaid Services (CMS) Medicare bundled payment reimbursement policy for OUD treatment and (2) the Substance Abuse and Mental Health Administration and CMS Medicare policies designed to facilitate access to treatment for OUD, specifically during the COVID-19 pandemic. MAIN OUTCOMES AND MEASURES: Study outcomes were trends in methadone and buprenorphine dispensing by beneficiary characteristics. National methadone and buprenorphine dispensing rates were calculated as claims-based dispensing rates per 1000 MA enrollees. RESULTS: Among the 39 252 MA enrollees with at least 1 MOUD dispensing claim (mean age, 58.6 [95% CI, 58.57-58.62] years; 45.9% female), 195 196 methadone claims and 540 564 buprenorphine pharmacy claims were identified, for a total of 735 760 dispensing claims. The methadone dispensing rate for MA enrollees was 0 in 2019 because the policy did not allow any payment until 2020. Claims rates per 1000 MA enrollees were low initially, increasing from 0.98 in the first quarter of 2020 to 4.71 in the first quarter of 2022. Increases were primarily associated with dually eligible beneficiaries and beneficiaries younger than 65 years. National buprenorphine dispensing rates were 4.64 per 1000 enrollees in quarter 1 of 2019, increasing to 7.45 per 1000 enrollees in quarter 1 of 2022. CONCLUSIONS AND RELEVANCE: This cross-sectional study found that methadone dispensing increased among Medicare beneficiaries after the policy changes. Rates of buprenorphine dispensing did not provide evidence that beneficiaries substituted buprenorphine for methadone. The 2 new CMS policies represent an important first step in increasing access to MOUD treatment for Medicare beneficiaries. FAU - Taylor, Erin A AU - Taylor EA AD - RAND Corporation, Santa Monica, California. FAU - Cantor, Jonathan H AU - Cantor JH AD - RAND Corporation, Santa Monica, California. FAU - Bradford, Ashley C AU - Bradford AC AD - The Paul H. O'Neill School of Public and Environmental Affairs, Indiana University, Bloomington. FAU - Simon, Kosali AU - Simon K AD - The Paul H. O'Neill School of Public and Environmental Affairs, Indiana University, Bloomington. FAU - Stein, Bradley D AU - Stein BD AD - RAND Corporation, Pittsburgh, Pennsylvania. LA - eng GR - R21 AG071925/AG/NIA NIH HHS/United States PT - Journal Article PT - Research Support, N.I.H., Extramural DEP - 20230501 PL - United States TA - JAMA Netw Open JT - JAMA network open JID - 101729235 RN - UC6VBE7V1Z (Methadone) RN - 40D3SCR4GZ (Buprenorphine) SB - IM MH - Humans MH - Male MH - Female MH - Middle Aged MH - *Methadone/therapeutic use MH - *Buprenorphine/therapeutic use MH - *Opioid-Related Disorders/drug therapy/epidemiology MH - *Medicare Part C MH - Opiate Substitution Treatment MH - Health Care Reform MH - Health Policy MH - United States MH - COVID-19 MH - Pandemics MH - Health Services Accessibility PMC - PMC10199341 COIS- Conflict of Interest Disclosures: Dr Taylor reported receiving grants from the National Institutes of Health and the National Institute for Health Care Reform outside the submitted work. Dr Cantor reported receiving funding from the National Institute of Mental Health outside the submitted work. Ms Bradford reported receiving grants from the National Institute on Drug Abuse outside the submitted work. Dr Simon reported receiving grant funding from the National Institutes of Health outside the submitted work. Dr Stein reported receiving grants from the Foundation for Opioid Response Efforts and National Institutes of Health outside the submitted work. EDAT- 2023/05/19 13:05 MHDA- 2023/05/22 06:42 PMCR- 2023/05/19 CRDT- 2023/05/19 11:33 PHST- 2023/05/22 06:42 [medline] PHST- 2023/05/19 13:05 [pubmed] PHST- 2023/05/19 11:33 [entrez] PHST- 2023/05/19 00:00 [pmc-release] AID - 2805031 [pii] AID - zoi230438 [pii] AID - 10.1001/jamanetworkopen.2023.14328 [doi] PST - epublish SO - JAMA Netw Open. 2023 May 1;6(5):e2314328. doi: 10.1001/jamanetworkopen.2023.14328.