Press Release

Collaboration with Ophelia Provides Highmark Wholecare Members With Access to Opioid Use Disorder Treatment

Issued by Ophelia

Mar. 21, 2024

• Pennsylvania saw nearly 15 drug-related overdose deaths a day in recent years
• Half a million Medicaid recipients diagnosed with opioid use disorder do not receive medication-assisted treatment
• Collaboration with Ophelia provides Highmark Wholecare Medicaid and Dual Special Needs members access to life-saving medication-assisted treatment via telehealth

NEW YORK -- Ophelia, an opioid addiction care provider, today announced a collaboration with Highmark Wholecare to provide access to high-quality, safe opioid use disorder (OUD) care services via telehealth to Highmark Wholecare's Medicaid and Dual Special Needs Plan (D-SNP) – individuals with both Medicaid and Medicare insurance – members. Ophelia has been part of Highmark Wholecare parent company Highmark Health's network in Pennsylvania since July 2021, serving 2.9 million commercial members. The new relationship offers Highmark Wholecare's 320,000 Medicaid and 40,000 D-SNP members in-network coverage for medication-assisted treatment (MAT), an evidence-based approach to OUD care that's considered the gold standard by the Centers for Disease Control and Prevention (CDC).

In 2021, Pennsylvania experienced nearly 15 drug-related overdose deaths every day – twice the national average. According to the CDC, synthetic opioids (including fentanyl), which are increasingly found in counterfeit pills, were some of the primary drivers of the increase in overdose deaths in the past several years. Yet 32% of insured Pennsylvanians reside in a zip code with no publicly listed provider who can prescribe life-saving buprenorphine, a medication approved by the Food and Drug Administration to treat opioid use disorder.

In addition to treatment deserts and localized provider shortages, people with OUD tend to experience financial hurdles when seeking treatment. Many treatment options do not accept commercial health insurance or Medicaid and have expensive out-of-pocket costs. The U.S. Department of Health and Human Services recently released a report that found half a million Medicaid recipients diagnosed with OUD do not receive medication. Access and financial and social barriers can force people with OUD to seek buprenorphine from illegitimate channels or continue their opioid use risking overdose and death.

"Pennsylvania has been working to address the opioid crisis for years, with far too many barriers standing in the way of people seeking and receiving life-saving treatment," said Ellen Duffield, president and CEO, Highmark Wholecare. "Highmark Wholecare's collaboration with Ophelia is helping course correct this crisis by providing access to comprehensive OUD care that our Medicaid and D-SNP members can receive quickly and safely."

When people seek OUD treatment, they are often required to travel to a clinic to receive a prescription, which can be logistically and financially challenging to coordinate. With Ophelia, patients can connect from home with care coordinators who help schedule telehealth appointments with Ophelia clinicians who have extensive education and training in psychiatry and addiction medicine. The clinician works with the patient to prescribe the necessary medication and helps manage their prescriptions. Researchers have found that patients who initiated treatment with buprenorphine or methadone were 76% less likely to overdose within three months and 32% less likely to have an opioid-related ER visit.

"Our expanded collaboration with Highmark Health through Highmark Wholecare members allows us to serve communities that continue to be severely impacted by the opioid epidemic," said Zack Gray, CEO and co-founder at Ophelia. "The more we can break down barriers to treatment, the faster we can provide effective medications and services to people living with OUD that can improve, even save, their lives."

For more information, visit: https://ophelia.com/.

About Ophelia Ophelia is a digital provider of medication-assisted treatment (MAT) for opioid use disorder (OUD), committed to making evidence-based treatment universally accessible. Its mission is to remove barriers for the 80% of Americans with OUD who are unable to access care. At its core is the Ophelia Care Model, a team-based clinical model and software platform developed by leading experts in addiction medicine and psychiatry. Ophelia is licensed to provide care in 49 states and D.C. and is contracted with Medicaid, Medicare, and Commercial insurers covering 85 million American lives.

About Highmark Wholecare We believe in caring for the whole person in all communities where the need is greatest. We see a future in which everyone has equal opportunity to achieve their best health. Through our leading Medicaid and Medicare programs, we are coordinating health care that goes beyond doctors and medicine that helps members achieve not just physical health, but also delivers whole person care. Our team members are helping to drive this new kind of health care for our 410,000 Medicaid and Medicare members in collaboration with a network of 29,000 primary care physicians, specialists, hospitals, and other ancillary providers. We are also committed to supporting our neighbors through our many community outreach and engagement programs.

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