Mass. insurers agree to cover methadone treatment

Previously, it was only covered by Medicaid and some private plans

BOSTON (State House News Service) – Private health insurance companies in Massachusetts will cover methadone treatment for people recovering from drug addiction starting this summer.

The change means one more path to combat the opioid epidemic, according to those who treat addicts.

Lora Pellegrini, chief executive officer and president of the Massachusetts Association of Health Plans, said health plans came to the decision individually after conversations with officials at the state Division of Insurance about addiction coverage. Previously methadone treatment was covered by only some private plans and all Medicaid plans.

“We are really trying to be part of the solution to a very serious problem,” Pellegrini told the News Service Thursday.

“It is one tool in a toolbox of things that are shown to be clinically effective to treat opiate addiction,” Pellegrini said, adding insurers do not favor one treatment option over another.

There are no estimates for how much the coverage will cost insurers, Pellegrini said.

Last spring, state health officials and Gov. Deval Patrick declared the opioid epidemic a public health emergency, and the Legislature subsequently passed a major substance abuse bill to address the growing problem. The law provides individuals fighting addiction improved access to treatment and recovery services, and requires insurers to cover up to 14 days in an in-patient treatment facility.

Sen. Jennifer Flanagan, a Fitchburg Democrat who helped steer the bill through the Legislature, said she was happily surprised when she first heard about the private health insurers’ decision to cover methadone.

“It is a great way to start the year to talk about insurance companies covering people,” Flanagan said.

Flanagan said it removes another obstacle addicts face to get treatment.

“I think it is certainly going to be a relief for some who are seeking recovery,” she said.

Pellegrini said there is a growing body of evidence that shows methadone, and other medication-assisted treatment, are effective forms of treatment for people suffering from addiction.

David Matteodo, executive director of the Massachusetts Association of Behavioral Health Systems, said the decision by private insurers is another positive step toward addressing the drug problem. The association includes 43 hospitals around the state that treat substance abuse.

“This is part of the toolbox that would be beneficial to have. We think people need the full range of services, methadone, Suboxone, and some people need in-patient care,” Matteodo said. “The patient should get what works best for them.”

Vic DiGravio, president of the Association for Behavioral Healthcare, said the move by health plans “sounds very promising,” and health insurers deserve credit for making the change. But, he added, it will depend on how insurers structure the benefit.

“One of the challenges with methadone treatment is it’s a daily regiment,” DiGravio said. “You have to go to a clinic every day.”

Some health plans already cover methadone treatment, but require co-payments, which DiGravio said can be cost-prohibitive for many people.

“If the co-pay is $20 a visit, that is $140 a week,” for treatment, he said. “It can very quickly make it not a realistic benefit.”

Secretary of Health and Human Services Marylou Sudders called methadone coverage a proactive step by insurers.

“This will add to the range of covered treatments for addiction, a serious disease which impacts far too many of our residents and their families,” Sudders said in a statement.

House Speaker Robert DeLeo also weighed in on the step taken by health plans, saying it will allow individuals to receive appropriate and specialized care.

“Through collaboration with advocates and organization like MAHP, the Legislature has laid a strong foundation for substance addiction treatment by increasing access to care and changing the way we respond to unprecedented public health crises like the one we’re currently confronting,” DeLeo said in a statement.

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