Report measures impacts of substance abuse treatment law

New state-mandated health coverage benefits beginning in 2015 for services such as alcohol and drug counseling or abuse-deterrent opioids will add roughly $2 to $18 a year to the cost of an annual policy, according to a report published Thursday by state health officials.

The Center for Health Information and Analysis (CHIA) on Thursday released its benefit review of the new mandates for health coverage included in the 2014 law passed by the Legislature and signed by Gov. Deval Patrick to increase opportunities for substance abuse recovery.

R

The law mandates that private health insurers cover abuse-deterrent opioids at the same level they cover non-abuse deterrent products, and requires coverage of licensed alcohol and drug counselors.

Insurers will also be required to cover in-patient substance abuse treatment for up to 14 days, and the law prevents insurers from requiring pre-authorization for a variety of substance abuse treatments.

With the new mandates set to kick in for policies issued or renewed on Oct. 1, 2015, CHIA reports that the new benefits will add an estimated $109,000 to the cost of health insurance in Massachusetts next year, and $5.5 million annualized in 2016.

While most of the state's largest health insurers already cover abuse-deterrent opioids, CHIA found that the drugs are relatively new and more expensive than traditional medications and carriers often put them in a different class with higher co-payments. That would be prohibited under the new law.

In 2011, unintentional injury was the fifth leading cause of death in Massachusetts, about a third of which have been attributed to drug overdoses, according to CHIA. The report states that while the alternative drugs have less potential to be abused, they do not alter a patient's potential for addiction, and addicts may substitute other drugs like heroin for prescription medications.

"Overall, evaluations of the effectiveness of new formulations in deterring abuse are still inconclusive, and further research is needed to understand fully their impact," the report says.

The number of drug overdoses in Massachusetts has tripled since 1990 to 11 per 100,000 people in 2010 with the majority attributed to prescription drug abuse. And while Massachusetts ranks 41st in the nation in opioid pain relievers prescribed per 100 people, the CHIA report says the state ranks ninth in the number of long-acting or extended release opioid prescriptions , which the Food and Drug Administration rates as the most likely to be abused.

During debate on the substance abuse treatment bill, the issue of in-patient services and prior authorization emerged as one of the more contentious points between lawmakers, insurers and the medical community.

"If the shift from insurer to provider for determining the necessity of treatment increases access to appropriate and adequate individually-targeted services, then Chapter 258 should positively affect outcomes for privately-insured patients with these illnesses," the CHIA report states.

The report, however, warns that demand for such treatment options may exceed the capacity of providers, and negatively impact the delivery of outpatient, early intervention and other treatment options.

The 138-page report contains analysis on not just cost, but also the medical efficacy of the provisions included in the laws. CHIA expects to issue additional reports in the coming months focused on substance abuse, including two reviews of proposed benefit mandates for medication assisted opioid treatment and substance abuse screening.

In February, CHIA plans to issue a report on access and barriers to substance abuse treatment, and the Behavioral Health Task Force on Health Data Policies and Long Term Stays will issue a separate report in July.

Governor-elect Charlie Baker said this week he intends to make substance abuse an early priority for his administration. "I really want to make a run at a pretty comprehensive approach to the heroin and opiate crisis, which I think is a huge problem and it cuts across geography, it cuts across class, it cuts across everything," Baker said.

Topics: 


Subscribe to the Dorchester Reporter