Background: On December 30, 2020, the United States (US) Centers for Medicare & Medicaid Services (CMS) issued State Health Official Letter #20-005 and required mandatory Medicaid State plan coverage of medication-assisted treatment (MAT) for opioid use disorders (OUD).
Objectives: This retrospective, descriptive analysis evaluated the impact of the Medicaid mandatory MAT benefit on OUD treatment utilization in 2018-2022.
Methods: Using the annually aggregated, product-level utilization and cost data of the CMS drug spending data, total Medicaid claims, dosage units, and spending (including both Medicaid reimbursement and out of pocket) of US FDA approved MAT treatments including methadone, buprenorphine, and naltrexone were identified, extracted, and compared (2018 vs. 2022). Methadone products included methadone hydrochloride tablets, Methadose, and methadone hydrochloride oral concentrate. Buprenorphine products included Sublocade, Suboxone, Zubsolv, buprenorphine and naloxone tablets and film, and buprenorphine tablets. Naltrexone included Vivitrol, an extended-release formulation of naltrexone.
Results: The total annual spending for methadone treatments increased from $10.4 million in 2018 to $27.8 million in 2022 (a 167% increase), with total annual claims increasing from 0.9 million in 2018 to 4.1 million in 2022 (a 356% increase) and dosage units increasing from 58.6 million in 2018 to 104.2 million in 2022 (a 78% increase). The total annual spending for buprenorphine treatments increased from $1,023.7 million in 2018 to $1,790.9 million in 2022 (a 75% increase), with total annual claims increasing from 6.3 million in 2018 to 9.3 million in 2022 (a 48% increase) and dosage units increasing from 164.6 million in 2018 to 283.1 million in 2022 (a 72% increase). The total annual spending for naltrexone increased from $254.2 million in 2018 to $334.3 million in 2022 (a 32% increase), with total annual claims increasing from 211,337 in 2018 to 244,133 in 2022 (a 16% increase) and dosage units increasing from 214,284 in 2018 to 349,129 in 2022 (a 63% increase).
Conclusions: We observed increased total Medicaid claims, dosage units, and spending of all three MAT treatments for OUD after the Medicaid mandatory MAT benefit in 2020. However, the magnitude of increase in number of claims and spending varied by individual treatment. Given the rising number of overdose deaths involving opioids during this time period (81,806 in 2022 vs. 49,860 in 2019), clinicians and policymakers need to collaborate to promote treatment awareness, expand treatment access, and reduce the risk of overdose deaths.
