Philadelphia News & Search
Saying that Pennsylvania cannot arrest its way out of the opioid epidemic, Attorney General Josh Shapiro laid out a 10-point plan that pushes for changes in health insurance coverage for addiction treatment.
Shapiro’s arguments — from expanding the number of treatment days covered to reimbursing organizations that hire certified recovery specialists to work with drug users — will likely be welcome to thousands of families that have been frustrated in getting insurance coverage for loved ones in substance abuse treatment.
His authority over the issue is somewhat limited, however. Shapiro has direct oversight of nonprofits, whose charitable missions are defined by law. The state insurance department can also refer egregious violations of Pennsylvania laws by any insurer for prosecution by the attorney general’s office. And, as Shapiro pointed out, in his new position as the state’s chief law enforcement officer he has a bully pulpit and has been speaking around the state about the opioid epidemic.
“This is our No. 1 public safety challenge in Pennsylvania, bar none,” Shapiro said in a short speech before a panel discussion about opioids Tuesday afternoon that was sponsored by the Independence Blue Cross Foundation. Just 54 percent of health insurance plans in the U.S. cover substance use treatment, he said, citing a national statistic that predates provisions in the Affordable Care Act that significantly increased coverage; some have been proposed for repeal by Republicans in Congress.
Many of Shapiro’s arguments come across as commonsense, but patients complained for years about the problems he is trying to address, and change has been slow. Even in Pennsylvania, whose laws governing treatment coverage are considered national models, families complain bitterly about treatment being cut short for lack of coverage, and sometimes blame insurers for overdoses after discharge.Treatment providers say that insurance companies put up roadblocks to coverage, both intentional and not.
“They do crazy things like call in and say ‘your patient has been in detox for a day. Has he improved?’ ” said Deb Beck, president of the Drug and Alcohol Service Providers Organization of Pennsylvania, pointing out that inpatient detox can take between three and 15 days, depending on the severity of addiction and how many drugs were involved. Almost no one comes in these days having abused just one substance, she said.
- Increase number of plans covering substance use disorder treatment
- Expand days of treatment covered
- Increase mental health coverage by enforcing parity requirements
- Remove pre-authorization for addiction treatment
- Add pre-authorization for opioid prescriptions
- Write initial opioid prescriptions for briefer periods of time
- Cover all medication-assisted treatments (the maintenance medicines methadone and Suboxone, and the opioid-blocker Vivitrol)
- Increase access to alternative pain treatments such as chiropractic, acupuncture, and treatment-related massage
- Encourage doctors to become certified to prescribe Suboxone
- Reimburse certified recovery specialists
Beck generally applauded the list but pointed out that nuances are important. She worried, for example, about more physicians prescribing the treatment medication Suboxone, which is intended to work alongside behavioral therapy, but is often prescribed by itself and can be abused.
She also said that there are major differences in coverage among insurance types, based partly on which are governed by state law. Large employers’ self-insured plans are left out and provide poor coverage, she said. Medicare coverage for the elderly also is limited, Beck said, while Pennsylvania law mandates relatively good coverage under Medicaid.
“I am happy to see the AG recognize that the best way to treat addiction is to prevent it,” said Samuel Marshall, president and CEO of the Insurance Federation of Pennsylvania, which represents insurers other than the Blues. He, too, said it was difficult to comment on the plan based on bullet points, but suggested that “special consideration be given to opioid abuse in workers compensation,” where “opioid prescriptions are uniquely high.”
Philadelphia News & Search