Commercial Health Plan Coverage of Selected Treatments for Opioid Use Disorders from 2003 to 2014

ABSTRACT

Opioid use disorders (OUDs) are receiving significant attention in the U.S. as a public health crisis. Access to treatment for OUDs is essential and was expected to improve following implementation of the federal parity law and the Affordable Care Act. This study examines changes in coverage and management of treatments for OUDs (opioid treatment programs (OTPs) as a covered service benefit, buprenorphine as a pharmacy benefit) before, during, and after parity and ACA implementation. Data are from three rounds of a nationally representative survey conducted with commercial health plans regarding behavioral health services in benefit years 2003, 2010, and 2014. Data were weighted to be representative of health plans’ commercial products in the continental United States (2003 weighted N = 7,469, 83% response rate; 2010 N = 8,431, 89% response rate; and 2014 N = 6,974, 80% response rate). Results showed treatment for OUDs was covered by nearly all health plan products in each year of the survey, but the types and patterns varied by year. Prior authorization requirements for OTPs have decreased over time. Despite the promise of expanded access to OUD treatment suggested by parity and the ACA, improved health plan coverage for treatment of OUDs, while essential, is not sufficient to address the opioid crisis.

KEYWORDS:

• ACA
• addiction
• insurance
• opioid
• treatment

Acknowledgments

The authors wish to acknowledge the contributions of Pat Nemeth, Frank Potter and staff at Mathematica Policy Research, Inc. (survey design, statistical consultation, and data collection), Grant Ritter (statistical consultation), Galina Zolutusky (statistical programming), and Ann-Marie Matteucci (research support) at Brandeis University. Preliminary findings were presented at the American Association for the Treatment of Opioid Disorders, March 2015.

Funding

This work was funded by the National Institute on Alcohol Abuse and Alcoholism (R01AA010869), the National Institute on Drug Abuse (R01DA029316), and the Brandeis-Harvard NIDA Center to Improve System Performance of Substance Use Disorder Treatment (P30DA035772). The funding agencies did not have any role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; or preparation, review, or approval of the article.

Additional information

Funding

This work was funded by the National Institute on Alcohol Abuse and Alcoholism (R01AA010869), the National Institute on Drug Abuse (R01DA029316), and the Brandeis-Harvard NIDA Center to Improve System Performance of Substance Use Disorder Treatment (P30DA035772). The funding agencies did not have any role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; or preparation, review, or approval of the article.