Minimum Insurance Benefits for the Treatment of Substance Use Disorders

CSAM Releases Results of Survey on Insurance Barriers to Medication-Assisted Treatment of Opioid Use Disorders 

The California Society of Addiction Medicine (CSAM) conducted a statewide survey during the September 2016 to assess insurance barriers in California to the treatment of patients with opioid use disorders. 

This survey documented that insurance-imposed barriers to medically-assisted treatment of opioid dependence continue to exist. Among the survey's findings: 

  • 62% of physicians whose patients have insurance coverage find it difficult to access medication-assisted treatment (MAT)
  • 46% experience barriers to maintenance treatment
  • 47% are unable to prescribe, due to coverage limits, the formulations that they believe are best for the patient
  • 35% experience difficulty prescribing the dose needed by their patient

A report, authored by David Kan, MD, CSAM President-Elect and Chair of the Committee on Opioids is being circulated to insurance providers and policy makers in California.

Read the report

Minimum Insurance Benefits for Substance Use Disorders

Californians with substance use disorders are grossly underserved. According to the 2007 state estimates from the National Survey on Drug Use and Health, 764,000 Californians needed but didn’t receive treatment for drug use and 2.3 million Californians needed but did not receive treatment for alcohol use.  At the end of 2014, CSAM released  the Consumer Guide and Scorecard for Health Insurance Coverage in California for Substance Use Disorders and Mental Health which revealed that insurance plans often do not meet minimum evidence-based standard for substance abuse treatment. In order to address this disparity, CSAM has produced three papers that propose minimum standards and document the evidence for these.  CSAM plans to meet with insurance providers to discuss the gap between these minimum standard and what is currently provided. These papers were adopted by the CSAM Executive Council on May 19, 2016.

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