Opioid use disorder treatment retention improves with insurance coverage: study

Insurance network coverage dramatically impacts whether a person remains in treatment for opioid use disorder, according to results shared by treatment provider Ophelia.

A new study finds that nearly three-quarters (72.3%) of patients receiving opioid treatment through network insurance stayed in treatment for at least six months. Patients received telehealth treatment from Ophelia.

Most insured members were Medicaid beneficiaries. Medicaid redeterminations, now at more than 17 million nationally, could seriously impact where individuals are able to get the treatment they need.

“When people are ready to seek OUD treatment, there should be no financial hurdles preventing them from receiving care,” said Arthur Robin Williams, M.D., chief medical officer for Ophelia, in a statement. “This study is a call to our entire healthcare system to do more to eliminate barriers to OUD treatment and for health networks to be more expansive and offer a broad range of treatment providers, including telehealth providers. We need to help people stay on track with treatment plans by making care affordable.”

For a 12-month period ending in April 2023, more than 111,000 people died due to drug overdoses. Fentanyl and other opioids accounted for nearly 70% of these deaths, reported CNN.

Even for insured patients that had to pay out-of-pocket because the plan was out of network, patients had worse retention. Out of network and uninsured patients had to pay a $195 monthly fee. Patients were 50% more likely to retain benefits at six months of care when receiving in-network care.

"Compared to cash-pay patients, those who could use in-network benefits had almost twice the retention rate for six months of treatment, a quality benchmark established by the CMS," a news release said. "Uninsured cash-pay patients had a 48.1% retention rate, which was higher than the 37% six-month retention rate of insured out-of-network cash-pay patients."

Ophelia CEO Zack Gray said it's important for insurers to cover OUD treatment, particularly in underserved areas.

"The results of this study prove that the opioid crisis that’s been impacting our nation for decades requires participation from health insurers, as a lack of coverage for OUD treatment is detrimental and possibly deadly for those who need help,” he said. “We need more insurers to offer coverage for effective opioid addiction treatment, and we need them to do so now."

The study analyzed 3,842 patients, over half of which were cash-pay patients.