Opioid recovery took a step forward with today’s release of the Mental Health and Substance Abuse Parity Task Force and the supplemental FAQ (frequently asked questions.)
The FAQ describes specific scenarios related to opioid recovery medications like buprenorphine (e.g. Suboxone), Naltrexone (e.g., Vivitrol) and Methadone. Here are some highlights.
- Q2: There is now a Parity Consumer Web Portal that can connect you to the appropriate agency. Visit www.hhs.gov/mental-health-and-addictioninsurance-help to identify the agency that can help you.
- Q5, Q6, Q7, Q8, Q9: Describe the barriers often encountered when attempting to obtain recovery medication. Most insurance companies would be breaking the law if they had these policies and did not have similar policies for medical/surgical conditions. The illegal practices are:
- Fail-first requirements such as mandatory counseling alone before people are authorized for recovery medication (Q7)
- Prior authorization by an insurer reviewer because of buprenorphine’s safety risks, if drugs with similar amount of risks don’t require prior authorization (Q6)
- Repeated prior authorization for recovery medications every 30 days when that is not the standard for other medications (Q8)
- Mandatory outpatient counseling requirements when there are no outpatient counselors in the geographic area but there are counselors for other conditions (Q5)
- Court-ordered treatment programs have to treat opioid addiction like they would other chronic diseases (Q9)
If your plan falls under the regulations of the ACA and the Mental Health Parity Act of 2008, this FAQ applies to you. Someone in the regulatory department of your insurance plan will know if it is subject to this law. You may also contact the Consumer Web Portal above and they may be able to advise you.
In summary, for most insurance plans the HHS guidance has put IN WRITING (that’s the news here) that these practices are a violation of the Mental Health Parity Act and that they are illegal.