More than two-thirds of state benchmark plans violate federal requirements to cover treatment for addiction disorders.
The National Center on Addiction and Substance Abuse surveyed addiction treatment benefits offered among 2017 Essential Health Benefits benchmark plans and found none offered a comprehensive array of addiction treatment benefits.
The report cites benchmark plans, which determine the minimum level of benefits available to those covered in state exchange plans, frequently “excluded or not explicitly covered benefits” related to residential treatment and the use of methadone as therapy.
“Addiction is a chronic disease that often goes untreated, and when patients can't access addiction treatment it can lead to disability and premature death,” said report author Lindsey Vuolo, associate director of Health Law and Policy at CASA. “We're really calling on states to amend their plans to comply with the law.”
Insurance plans are required under the Affordable Care Act to cover essential health benefits, which include providing services for behavioral health and substance use disorder treatment at parity with medical care.
Despite federal rules that require plans to cover addiction treatment without restrictions, the ACA does not specify which substance use disorder benefits should be covered, leaving that decision up to the discretion of states.
The law requires plans cover at least one addiction treatment medication in each of four classes: anti-craving, opioid reversal, opioid dependence treatments and tobacco cessation. The report found that 45% of 2017 benchmark plans were in violation by not providing coverage for an addiction treatment medication that was in each of the four classes.
Half of benchmark plans also violated essential health benefit requirements by not covering anti-smoking services, which include screenings, up to eight counseling sessions a year, and one 90-day treatment of any anti-smoking medication approved by the Food and Drug Administration.
EHB-benchmark plans for Alabama, Michigan, Mississippi, South Carolina and South Dakota violated parity rules that prohibit limits on treatment that applied to addiction treatment only by restricting the number of visits allowed for such services.
Calls for more comprehensive coverage of addiction treatment services have grown louder over the past few years as the number of drug overdose deaths have reached record levels. More than 28,000 people died in 2014 from overdoses involving opioid drugs, including heroin.
Last year, the federal government suggested including coverage of the full range of approved medication-assisted treatments as part of the essential health benefits to ensure more access to such therapies. But the proposal faced opposition from insurers and pharmacy benefit managers and was struck down.
