Insurance Companies Want Reforms in Treatment for Substance Abuse

Health insurance companies, facing an increase in claims for substance abuse treatment, are pushing for changes such as emphasizing medication-assisted treatment over abstinence, according to the Hartford Courant.

Insurers also want to limit prescriptions for opioids and evaluate treatment programs.

Part of the reason the companies are seeing a surge in substance abuse treatment claims is that more 19- to 26-year-olds have insurance, the article notes. The proportion of claims involving opioids is increasing, especially among teens and young adults. Alcohol remains the largest substance abuse problem.

Cigna’s opioid claims rose from 20 percent of substance abuse cases five years ago to 25 to 30 percent today. Drug and alcohol abuse claims at Aetna rose over the past four years from 15 percent of mental health spending (not including prescriptions) to 30 percent currently.

In May, Cigna announced it is teaming up with the American Society of Addiction Medicine (ASAM) to study which substance abuse treatments are effective.

The company will provide two years of medical claims data to ASAM, who will work with health researchers at Brandeis University to test and validate which treatments are working. All patient names have been removed to ensure confidentiality.

The results could be used to develop guidelines for Cigna and other health insurers to establish protocols for doctors and other mental health providers, the article notes.