Trends in Buprenorphine and Methadone Dispensing Among Medicare Advantage and Commercial Enrollees, 2019-2024

Introduction

Despite the existence of effective medications for opioid use disorder (MOUD), including methadone and buprenorphine, overdose deaths remain high. In 2020, Medicare began covering methadone for the treatment of opioid use disorder (OUD), and separate federal policy changes expanded MOUD access via telemedicine in response to the COVID-19 pandemic. However, little is known about national trends in methadone and buprenorphine dispensing across commercial and Medicare Advantage (MA) payers, especially by patient characteristics.

Methods

A retrospective repeated cross-sectional study was conducted using 2019–2024 data from Optum’s de-identified Clinformatics® Data Mart Database to examine quarterly methadone and buprenorphine dispensing rates per 100,000 OUD-diagnosed enrollees. Rates were stratified by insurance type (commercial vs. Medicare Advantage), age, and dual eligibility status. Joinpoint regression identified statistically supported trend inflection points and annual percent changes (APCs) per segment.

Results

Among OUD-diagnosed enrollees, MA methadone rates rose from 624 to 5,462 per 100,000 between 2020Q1 and 2024Q2 (AAPC +104.6%/year), while commercial methadone rates increased from 3,552 to 6,821 per 100,000 (AAPC +23.9%/year) during the same period. MA buprenorphine rates increased steadily (AAPC +20.7%/year), while commercial buprenorphine peaked in 2022 and declined at -20.0%/year after 2023Q2. Dually eligible MA enrollees under age 65 had the highest MOUD dispensing rates throughout.

Conclusions

Methadone dispensing increased substantially among MA enrollees with OUD after 2020, particularly among dually eligible beneficiaries younger than 65 years. The post-2022 commercial buprenorphine decline in dispensing warrants further investigation. Tailored efforts may be needed to close payer-related treatment gaps and support broader MOUD access.