Availability of Medications for Alcohol Use Disorder Treatment in Medicare Part D, 2014–2018

Objective: Despite increases in alcohol-related mortal-ity, excessive drinking, and alcohol use disorder (AUD) among older adults, the availability of medications for alcohol use disorder (MAUD) for Medicare Part D beneficiaries has not yet been examined. Method: Prescription data from the Medicare Part D Public Use File were aggregated to the county-year level for the years 2014 to 2018. Descriptive statistics and paired t tests were used to examine changes in the availability of MAUD from 2014 to 2018. Two-part multivariable regression models were used to examine the association between county-level characteristics and MAUD availability. Results: The percentage of counties across the U.S. offering any MAUD increased by 10% over the study period. The mean number of MAUD providers in counties with at least one provider increased by 1.81 providers over the study period, from 3.51 providers per county in 2014 to 5.32 providers in 2018. A higher percentage of counties had access to oral naltrexone, which was offered by at least one provider in 23% of counties in 2014 and 33% of counties in 2018. However, a majority (65%) of counties did not have any MAUD providers in 2018. Regression results showed a significant association between MAUD availability and census region, racial/ethnic composition of counties, AUD rate, and year. Conclusions: The low rates of MAUD availability for Medicare Part D beneficiaries are concerning given that older adults are particularly vulnerable to negative health implications associated with AUD. Targeted efforts are needed to appropriately ad-dress increasing AUD prevalence, morbidity, and mortality among older adults enrolled in Medicare.