A new study by HHS’ Assitant Secretary for Planning and Evaluation (ASPE) Use of Medication-Assisted Treatment for Opioid Use Disorders in Employer-Sponsored Health Insurance: Final Report, shows some positive results as far as treatment coverage likely due to recent changes in the nation’s health care laws including the Affordable Care Act and the Mental Health Parity law. It also shows the impact of the increased use of opioids. The study compared treatment use in the period of 2006-7 to 2014-15 and examined coverage, utilization and spending. The report concluded that:
“These findings highlight how the MHPAEA [mental health parity law] and the ACA as well as new FDA-approved MAT [medication-assisted drug] expanded OUD [opioid use disorder] treatment coverage, utilization, and expenditures in the private health insurance market between 2006-2007 and 2014-2015…our findings reflect expanded availability, greater use of OUD treatment services, and higher payments to service providers for enrollees in large employer-sponsored health plans.”
The report indicates that total spending through private insurance plans increased from 13 percent to 18 percent between the two periods and that claims for substance abuse services increased from $71 million to $721 million between the plans examined from 2011 to 2015.
According to the research, in 2014 opioid treatment programs were covered in 97 percent of private plans, and all health plans covered the treatment medication buprenorphine under the pharmacy benefit in 2010. This is one example of MATs.
A higher percentage of plans paid for intensive outpatient treatment, outpatient office visits, and psychotherapy but they also found that while there was a substantial increase in residential treatment, still only 13 percent of plans paid for this type of treatment in 2014-2015 and that
“the continued lower coverage of higher-intensity services–residential, intensive outpatient, and partial hospitalization–reflects a lack of coverage for higher-intensity services.”
Although the report shows increased coverage and use the HHS report cautions:
“…there remain significant barriers to treatment access. The higher cost and lower insurance reimbursement for inpatient care and lower utilization of residential services reflects a lack of availability of higher-intensity services which may be needed for more severe cases of OUD, particularly during treatment initiation before patients can be transitioned successfully to outpatient treatment. Further, only half of those who could potentially benefit from MAT received it, and access to MAT was even lower for women and enrollees below or above the 18-44 year age range.”