ACA plans' addiction coverage 'could be better'

Close-up photo of prescription pill bottle and label

Coverage for alcohol and opioid abuse treatment under Affordable Care Act insurance marketplace plans is good--but it could be better, according to research by the Urban Institute.

Researchers looked at every silver insurance exchange plan in several large cities, including Chicago, Kansas City and Los Angeles. They evaluated coverage, ease of use and out-of-pocket costs.

The executive summary (pdf) said coverage is “generally good,” but noted marketplace plans vary significantly in coverage and the degree of cost-sharing required for medication-assisted treatment. They also varied in the level of inpatient and outpatient services covered.

Variances included which medications were covered, whether prior authorization was required and whether the quantity of drugs that could be prescribed was limited.

Co-insurance payments were frequently required for inpatient services, raising issues about transparency in pricing, according to the report. Co-payments were more common for outpatient services. “Converting co-insurance to co-payments would greatly improve consumers’ ability to make informed choices about which plan best meets their specific treatment needs,” according to the executive summary.

All of the plans needed to be more transparent about whether they would pay for methadone treatment, according to the summary.

The research was conducted with the support of the Robert Wood Johnson Foundation.

- see the announcement

- here’s the executive summary (pdf)

- read the full report (pdf)