Tracking Medicaid-Covered Prescriptions to Treat Opioid Use Disorder
Last updated April 23, 2020
State Medicaid programs are on the front lines of addressing the opioid crisis by expanding access to evidence-based treatment. Data on Medicaid-covered prescriptions used to treat opioid use disorder show how quantity and spending trends have changed over time and whether states are meaningfully increasing access to these medications.
This tool tracks national and state data on two types of medications used to treat opioid use disorder (buprenorphine and naltrexone) and one medication used to treat opioid overdoses (naloxone). We will update these data to show long-term trends and up-to-date Medicaid prescribing and spending patterns.
Making effective treatment for opioid use disorder more widely available is essential to staunching the opioid epidemic. Access to these treatments is particularly important in Medicaid, because Medicaid covers a disproportionately large share of people with opioid use disorder (OUD). But despite strong evidence supporting the effectiveness of medication-assisted treatment for OUD, few people with OUD receive treatment.
In this project, we are examining prescriptions and spending on three medications approved by the Food and Drug Administration for the treatment of opioid use disorder and overdose—buprenorphine, naltrexone, and naloxone—from the Medicaid State Drug Utilization Data. Our analysis shows that prescriptions and spending on these medications have grown dramatically since 2010. Between 2010 and 2018, Medicaid spending on OUD treatment prescriptions for buprenorphine, naltrexone, and naloxone increased from $245.5 million to $1,329.5 million, before adjusting for the federal rebates drug manufacturers paid to state Medicaid programs and not including dispensing fees.
From 2013 to 2018, the number of Medicaid-covered buprenorphine prescriptions for OUD increased 3.7-fold from 1.75 million to 6.52 million, naltrexone prescriptions increased 5.5-fold from 99,000 to 549,000, and naloxone prescriptions increased 41.7-fold from 6,000 to 236,000. Yet opioid-related death rates remained high into 2018, suggesting that treatment rates for OUD and opioid overdose are not meeting demand.
As new quarterly data are released, we will publish new analyses tracking changes in Medicaid spending and prescription patterns, emerging state and national trends, and policy implications. As of February 11, 2020, we show estimates of both unadjusted spending and spending adjusted for the federal Medicaid rebate.
ABOUT THE DATA
We use the Medicaid State Drug Utilization Data from the Centers for Medicare & Medicaid Services that has information on Medicaid-covered outpatient prescriptions for buprenorphine, naltrexone, and naloxone. We identify buprenorphine medications (including buprenorphine/naloxone medications) the Federal Drug Administration (FDA) has approved for treating opioid use disorder and naltrexone prescriptions that are FDA approved for blocking the effects of opioids. (Naltrexone medications are also FDA approved to treat alcohol dependence, but the dataset cannot distinguish between different uses.) We include naloxone medications when the FDA’s primary indication of use is to reverse opioid overdose. We focus on the number of prescriptions and Medicaid spending (i.e., Medicaid reimbursements) for each of the three types of medications, which can be examined for generic and brand-name drug categories. The data will be updated quarterly and are subject to revisions, exclusions, and limitations. See the study methodology for more details about tracking Medicaid-covered prescriptions to treat opioid use disorder. And see the Medicaid enrollment methodology for more information about estimating Medicaid enrollment.
Learn more about Urban Institute’s work on the growing opioid crisis.
RESEARCHERS: Lisa Clemans-Cope, Victoria Lynch, Marni Epstein, Emma Winiski, and Doug Wissoker.
This tool was funded by the Laura and John Arnold Foundation. We are grateful to them and to all our funders, who make it possible for Urban to advance its mission.