AMA supports efforts to improve substance abuse disorder coverage

Experts from four leading nonprofits in the addiction field have determined that existing legislation does not adequately protect insurance coverage of substance abuse disorders, according to a press release.

The AMA was quick to respond, calling the report “a wake-up call” that should inform health insurers of their legal obligations to protect their patients.

“This new report from the Addiction Solutions Campaign reveals the significant challenges that patients face when seeking treatment for a substance use disorder,” Patrice A. Harris, MD, chair of the AMA Opioid Task Force and immediate past chair of the AMA Board of Trustees, said in a statement. “This report makes it clear that health insurers and regulators need to take a hard look at their legal obligations to ensure that patients receive the full benefits of existing parity laws covering mental health and substance use disorders.”

The Addiction Solutions Campaign (ASC), comprising experts from the National Center on Addiction and Substance Abuse, the Legal Action Center, Partnership for Drug-Free Kids and the Treatment Research Institute, aims to secure coverage for addiction treatment as stated in the Mental Health Parity and Addiction Equity Act of 2008 (Parity Act). The legislation requires equitable coverage of substance abuse disorders and mental health benefits in public and private insurance markets. The Act prevents discriminatory insurance coverage for those with mental health and substance disorders, mandating that insurance plans’ standards for substance use and mental health benefits be equal to those for other medical/surgical benefits.

After assessing publicly available documents for seven major health plans offered in 2015 and 2016 in New York and Maryland group markets, the ASC found that the current enforcement framework of the Parity Act may not adequately protect these rights. Current enforcement of the Parity Act fails to aid the millions of Americans unable to access treatment.

“When a patient seeking care for an opioid use disorder is forced to delay or interrupt ongoing treatment because of a health plan utilization management coverage restriction — such as prior authorization — that can be harmful to their care and health,” Harris said. “With respect to opioid use disorders, that could mean relapse or death from overdose.”

On behalf of families and consumers affected by this limited access, the ASC is advocating to shift from the current enforcement framework, which depends on individuals notifying regulators about violations and appealing coverage denials, to prospective regulatory review. They recommend that insurance regulators get a “Parity Transparency and Compliance Report” from insurers confirming that they are responsive to the Parity Act’s standards enabling them to perform a comprehensive plan review before approval.

“Increasing access to treatment is an essential component of reversing the nation’s opioid epidemic,” Harris said. “We hope this report spurs insurers and regulators to act. The AMA is ready to work with them and all stakeholders to advance policies that will help our patients.”

Disclosures: Harris is chair of the AMA Opioid Task Force.