treatment* to pregnant illicit drug users and
calculated an average net savings of $4,644 per
mother/infant pair.^77
An examination of health care and pharmacy
costs for patients with addiction involving
opioids in a large U.S. health plan revealed that
total health care costs (including inpatient,
outpatient and pharmacy costs) six-months post-
treatment were 29 percent lower for patients
who received medication than for patients who
received medication-free treatment ($10,192 vs.
$14,353).^78
A study of the cost effectiveness of short-term
opioid replacement therapy† compared to
detoxification only calculated a cost-
effectiveness ratio of $1,376 in opioid
replacement therapy costs per quality-adjusted
life year (QALY).^79 Another study projected
that methadone maintenance therapy costs
$5,915 for every year of life gained.‡ 80 In HIV
populations, expanding methadone maintenance
capacity for heroin users is cost effective, at
$8,200 per QALY gained in communities with
40 percent HIV prevalence among injection drug
users and $10,900 per QALY gained in
communities with five percent HIV prevalence
among injection drug users.^81
- One week of residential care followed by intensive
outpatient (day treatment) services through labor/
delivery.
† Patients, ages 15-21, received 12 weeks of
buprenorphine-naloxone therapy and also were
offered twice-weekly counseling.
‡ Assuming annual treatment costs of $5,250.
Insurance Coverage of Addiction Treatment is Limited ..................................................
Recently-enacted federal and state parity laws
have expanded coverage for addiction treatment
where offered, and the Patient Protection and
Affordable Care Act (ACA) holds potential for
further expansion of access and benefits.
However, insurance coverage of addiction
treatment remains severely limited in both the
populations and services that are covered. The
absence of mandated coverage in all health plans
means that some health plans may continue to
choose not to provide coverage for addiction
treatment, persisting to deny access to patients
who need it.^83Parity Laws ................................................................................................................
Federal and state parity laws require private
insurers that provide mental health and addiction
treatment services to provide them on par with
medical services. In general, restrictions placed
on addiction services (e.g., co-pays, deductibles)
cannot be more restrictive than restrictions
placed on other medical services.^84Specifically, while the Mental Health Parity Act
(MHPA), passed in 1996, did not apply to
addiction treatment,^85 the 2008 Paul Wellstone
and Pete Domenici Mental Health Parity and
Addiction Equity Act (MHPAEA) was enacted,
in part, to address this omission.^86 The
MHPAEA provisions apply to: Plans sponsored by private and public sector
employers with more than 50 employees and
that include medical/surgical and mental
health/addiction benefits;§§ Applies to plan years beginning on or after July 1,
2010.The use of evidence-based approaches in
treatment will be driven by policy. We need to use
the payment system to drive changes in practice.^82--Jeffrey Samet, MD
Professor of Medicine and Social Behavior,
Clinical Addiction Research and Education
(CARE) Program
Boston University School of Medicine