title: 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.
authors.affiliation: a Senior Scientist, Institute for Behavioral Health, Heller School for Social Policy and Management , Brandeis University , Waltham , MA , USA.
authors.forename: Sharon
authors.initials: S
authors.lastname: Reif
authors.affiliation: b Research Associate (TBC)1, Institute for Behavioral Health, Heller School for Social Policy and Management , Brandeis University , Waltham , MA , USA.|c Associate Research Scientist, Cambridge Health Alliance , Cambridge , MA , USA.
authors.forename: Timothy B
authors.initials: TB
authors.lastname: Creedon
authors.affiliation: d Professor and Director, Institute for Behavioral Health, Heller School for Social Policy and Management , Brandeis University , Waltham , MA , USA.
authors.forename: Constance M
authors.initials: CM
authors.lastname: Horgan
authors.affiliation: e Scientist, Institute for Behavioral Health, Heller School for Social Policy and Management , Brandeis University , Waltham , MA , USA.
authors.forename: Maureen T
authors.initials: MT
authors.lastname: Stewart
authors.affiliation: f Professor, Institute for Behavioral Health, Heller School for Social Policy and Management , Brandeis University , Waltham , MA , USA.
authors.forename: Deborah W
authors.initials: DW
authors.lastname: Garnick
mesh_terms: D002047:Buprenorphine / Q000008:administration & dosage; D006297:Health Services Accessibility / Q000331:legislation & jurisprudence*; D006801:Humans; D019458:Insurance Coverage / Q000706:statistics & numerical data* / Q000639:trends; D007348:Insurance, Health / Q000706:statistics & numerical data* / Q000639:trends; D058850:Opiate Substitution Treatment / Q000379:methods; D009293:Opioid-Related Disorders / Q000534:rehabilitation*; D058991:Patient Protection and Affordable Care Act; D011634:Public Health; D011795:Surveys and Questionnaires; D014481:United States
chemical_list: D002047:Buprenorphine
keywords: ACA; addiction; insurance; opioid; treatment