Answer Addiction

Tag: insurance coverage

  • Inadequate Mental Health Treatment Hinders Massachusetts Residents

    Inadequate Mental Health Treatment Hinders Massachusetts Residents

    Only about 50% of Massachusetts mental health providers accept payment from the state and federal Medicaid program. Private insurance isn’t much better.

    Patients in Massachusetts are struggling to receive adequate mental health care but not because of lack of insurance coverage. 

    The Boston Globe reports that based on a new Blue Cross Blue Shield of Massachusetts Foundation survey of 2,201 residents, more than half recently sought mental health or substance use disorder treatment but had difficulty receiving such treatment.

    Of those surveyed, 39% went without treatment altogether and about 13% resorted to an emergency room visit even though about half of those admitted that their care was not an emergency. 

    Though insured, the majority of patients struggled to find care because certain providers did not take their insurance or because practices were not accepting new clients at the time. 

    In October, the Globe reported that Massachusetts was home to more mental health care providers per capita than any other US state. It also has more psychiatrists than any other state, with the exception of Washington, DC, and more child psychiatrists than all states but Rhode Island and DC. 

    Even so, residents of the state are struggling. According to The Globe, only about 50% of Massachusetts providers accept payment from the state and federal Medicaid program. And private insurance isn’t much better, as only about half the psychiatrists in the Northeast accept it. 

    Audrey Shelto, president of the foundation that conducted the survey, told The Globe that this was the first time since the survey began a decade ago that it asked about mental health and substance use disorder treatment access.  

    “If change is going to happen at the magnitude that’s needed, it’s going to be necessary that we start building a more solid evidence base,” Shelto said.

    According to Shelto and others in the field, one possible solution would be paying psychiatrists, psychologists and social workers more, because private insurers and Medicaid currently do not pay them enough. Those in the practice also spend a great deal of time on applications for insurance networks as well as paperwork for patient treatment. 

    According to The Globe, Health and Human Services has stated that between 2016 and 2020, Medicaid is increasing fees to mental health providers by $100 million. 

    But Vic DiGravio, president of the Association for Behavioral Healthcare in Natick, told The Globe this isn’t enough to convince more providers to join the program. 

    DiGravio adds that access to prescribers such as psychiatrists are one of the biggest battles being faced currently. 

    “For a clinic to have a doctor on staff to see patients on a regular basis, the rates don’t cover their time,” he said.

    View the original article at thefix.com

  • OxyContin No Longer Covered By Some Insurers

    OxyContin No Longer Covered By Some Insurers

    “This is a whack-a-mole solution… I don’t believe we should be isolating one category of opioid versus another,” said one expert.

    Some insurers are taking a rather bold stand against the opioid crisis by refusing coverage of OxyContin, a popular brand-name opioid painkiller. 

    The decision, according to the Houston Chronicle, has drawn controversy as some people question whether refusing to cover one specific medication will really make a difference. 

    “This is a whack-a-mole solution,” James Langabeer, professor of emergency medicine at McGovern Medical School at UTHealth, told the Chronicle. “On the one hand, it’s good that the insurance industry is weighing in, but I don’t believe we should be isolating one category of opioid versus another.”

    OxyContin, a brand name for oxycodone, is manufactured by Purdue Pharma, a company that has faced a slew of federal lawsuits for its alleged role in fueling the current opioid crisis.

    One concern, Langabeer says, is that denying access to OxyContin won’t necessarily force individuals to stop abusing opioids. In fact, he says, some may even begin using heroin instead, as it’s cheaper and more accessible.

    The Chronicle reports that last week, Blue Cross and Blue Shield of Tennessee announced that it will discontinue coverage at the start of 2019, stating it was “drawing a line that we will not continue to pay for this.”

    Previously, Cigna and UnitedHealthcare also announced the same. 

    A Cigna spokeswoman told the Chronicle via email that Cigna will consider covering the medication in some situations if a doctor feels it is “medically necessary.” She added that those using the medication for hospice care or cancer treatment will be allowed to continue use.

    UnitedHealthcare ceased to cover OxyContin in employer-sponsored plans beginning January 2017, according to the Chronicle.

    “There are therapeutically equivalent, covered alternatives that can be used for pain indications,” a spokesman for UnitedHealthcare told the Chronicle via email.

    Cigna, as well as insurer Florida Blue, will be replacing OxyContin with Xtampza, which they claim is more difficult to abuse. 

    Purdue Pharma has not been silent as insurance companies have rolled out these decisions. The company, according to the Chronicle, argues that it has been working to make the medication harder to abuse. It has also accused insurers of supporting its competitors for “financial gain.”

    “These recent decisions by insurance companies limit prescribers’ options to help address the opioid crisis,” a company spokesman told the Chronicle via email. “Unfortunately, these decisions appear to be more about pharmaceutical rebates.”

    Katharine Neill Harris, a fellow in Drug Policy at Rice University’s Baker Institute of Public Policy, tells the Chronicle that she has mixed feelings about the involvement of insurers. 

    “They do have a role and I don’t think they have done enough yet,” she said. “The easiest way to say we’re doing something is by stopping covering a drug.”

    For Harris, a better alternative is for insurers and doctors to look into long-term solutions for chronic pain, such as physical therapy.

    View the original article at thefix.com

  • Too Often, Insurers Cover Opioids But Not Addiction Treatment Meds

    Too Often, Insurers Cover Opioids But Not Addiction Treatment Meds

    “Buprenorphine and methadone are incredibly effective medications… So I really do think it’s a stigma issue.”

    As is the case for many people battling opioid addiction, Mandy’s dependency started at home. She was prescribed an opioid for back pain, and her insurance company gladly covered the cost of the pills.

    However, after Mandy became dependent on opioids and was prescribed buprenorphine to help with her rehabilitation program, her insurer stepped back, unwilling to pay.

    “It makes me want to go out and use [drugs],” Mandy said when she spoke to Vox. The 29-year-old who lives in the Chicago area asked that only her first name be used. “It’s way easier to get opiates or heroin… It’s so much easier than dealing with this bullshit.” 

    Many Americans who had no problem getting their insurance companies to pay for addictive opioid pain pills have found that getting insurers to cover treatment—particularly medication-assisted treatment (MAT) that relies on pharmaceuticals like buprenorphine—is an uphill battle despite the fact that the drugs have been proven effective. 

    “Buprenorphine and methadone are incredibly effective medications,” said Tami Mark, a health economist at RTI International, a non-profit that conducts policy research. “If you had any other drug with their kind of effect size, it would be immediately covered… So I really do think it’s a stigma issue.”

    For people in early recovery, like Mandy, refusals to cover medications or delays in getting prescriptions approved can be deadly.

    “The risk of relapse is incredibly high,” said Sara Ballare-Jones, a social work case manager at the University of Kansas Health System. She often has patients wait three days to get their medications approved because they require prior authorization from the insurance companies.

    In Mandy’s case her claim was denied, leaving her to pay out of pocket for buprenorphine, which costs nearly $3,000 each year. The 29-year-old said that is a huge amount to have to pay while also handling daily expenses like student loans and rent.

    “I’m feeling all these old issues and all this shit, and then it’s just more bullshit,” she said. “I’m just trying to reenter society… It’s really hard.”

    It’s also incredibly frustrating for Mandy, who knows firsthand how easy it is to get insurers to cover opioids. “I never paid a dime for my opioids. Those were always covered,” she said. “But I’m paying all this money for the treatment.”

    Mandy’s doctor, Dennis Brightwell, said that he usually sees issues with private insurance companies. While Medicaid is required to cover most medication-assisted treatments, most private insurers balk at covering them, putting vulnerable patients in an awkward position.

    “If you send a commercial patient to the pharmacy, you don’t know until they get there how it’s going to go,” Brightwell said. “Sometimes it’s not such a problem. Sometimes it’s a prior authorization that is pretty straightforward. Sometimes it’s very difficult to get them to approve it. And there’s not an easy way to find out upfront what medications they approve.” 

    View the original article at thefix.com