It’s no secret that an opioid epidemic is sweeping the country. The crisis is so far-reaching that it affects a countless number of individuals in every corner of the United States. If your employees are not directly affected, chances are they know somebody who is, be that a family member or friend. As an employer, it’s important to understand your responsibilities when it comes to providing treatment for opioid addiction.
The Unintended Consequences of Health Insurance
Employer health care plans are meant to help relieve the burden of high medical costs on your staff and their families. Unfortunately, this very protection may inadvertently be contributing to the opioid epidemic.
Opioid addiction often begins innocently enough: through misuse of a legal drug prescribed to treat pain following a surgery or accident. Most health plans offer prescription drug benefits, so access to these medications isn’t difficult. Studies indicate around 40 percent of individuals who are dealing with opioid addiction are covered by group health plans.
Recognizing the need for a solution, in 2016 the Comprehensive Addiction and Recovery Act was established in an effort to reduce costs and improve access to drug abuse treatment programs. The law defined addiction as a chronic health condition and includes additional pending legislation that would allocate $6 billion in federal funds toward treating the epidemic. Add to this the high ancillary health care costs associated with treatment, and many employers are rethinking their health plans.
Coverage for Addiction and Treatment
Due to government regulations stipulating that group health plans must provide coverage for substance abuse treatment equivalent to the coverage offered for medical and surgical costs, most health plans cover treatment and counseling for employees and their families affected by opioid addiction.
All individual and small group health plans are required to offer mental health and substance abuse benefits equal to those offered for standard medical and surgical; there can be no higher limits imposed on costs or frequency of treatment. You’ll want to take a close look at your health care coverage to make sure you are meeting your legal requirements. It’s important that your employees know this coverage is available and understand that HIPAA requirements ensure privacy and confidentiality. Employers cannot access treatment information, and only those individuals responsible for managing benefit plans have access to health care claims.
Going Above and Beyond What’s Required
While not required by law, there are other steps employers can take to encourage treatment for opioid addiction. These include removing prior authorization requirements for anti-opioid medications and in-patient treatment facilities, imposing strict quantity limits on opioid drugs, offering alternative therapies such as acupuncture and massage therapy, ensuring your plan has out-of-network options if treatment facilities are not available locally, and offering telemedicine options.