Insurance Spending on Addiction Treatment Rising

Insurance Spending on Addiction Treatment Rising

Insurers' spending on services for patients diagnosed with opioid abuse or dependence increased 1000 percent from 2011 to 2015, says a report from Fair Health, a nonprofit databank that provides cost information to the health industry and consumers. The report includes treatment costs for both licit and illicit opioids.

'Total charged amount' in that 5-year period increased from $71.66 million in 2011, to $721.80 million in 2015, a 10-times or 1000 percent increase.

'Total allowable amount' - insurers' payments for patients to treatment centers, laboratories, hospitals and other medical providers - increased by 14 times, or 1400 percent, from $32.42 million to $445.74 million.

The latest figures represents a fraction of the total cost of medical care in America, says a report from NPR. But the rapid rise in addiction treatment funding,

"is cause for concern," says Fair Health president Robin Gelburd. "That really shows the stress on the health system and the impact on the individuals."

Decline in opioid prescriptions

Another new report, from the Peterson-Kaiser Health System Tracker, echoes the same increases in insurance spending on opioid addiction treatment as the Fair Health report, but for a longer period. And it also shows a steep decline in insurance billings since 2009 for prescription opioids.

This illustrates the ongoing shift away from prescription opioids to street drugs since 2009. Less than a decade ago, prescription opioids were the leading cause of opioid addiction and dependence. Today, street drugs like heroin and fentanyl are the leading cause.

The System Tracker charts the percentage of the types of insurance coverage for non-elderly adult patients with opioid dependencies, based on samples of health benefit claims from the Truven MarketScan Commercial Claims and Encounters Database.

Roughly four in ten patients who received opioid prescriptions - 38 percent - were covered by private health insurance. Medicaid covered a similar share at 37 percent. Uninsured patients totaled 17 percent, and the insurance status of the remaining 8 percent was "unknown."

"Opioid prescription use and spending among people with large employer coverage increased for several years before reaching a peak in 2009," the report says. "Since then, use of and spending on prescription opioids in this population has tapered off and is at even lower levels than it had been more than a decade ago."

According to the report,

the drop-off in opioid prescribing since 2009 is similar for all major disease categories, including cancer, but was most pronounced among people with complications from pregnancy or birth, musculoskeletal conditions, and injuries.
"The cost of treating opioid addiction and overdose - stemming from both prescription and illicit drug use - among people with large employer coverage has increased sharply," the report says, rising to $2.6 billion for addiction treatment and overdoses in 2016 from $0.3 billion 12 years earlier in 2004 - a more than nine-fold increase."

Half of that was for outpatient treatment, while $911 million was for inpatient care and $435 million was for prescription drugs.

Age and gender also charted

"Opioid prescription use among people with large employer coverage is highest for older enrollees: 22 percent of people age 55-64 had at least one opioid prescription in 2016, compared to 12 percent of young adults and 4 percent of children.
"Women with large employer coverage are somewhat more likely to take an opioid prescription than men (15 percent compared to 12 percent). Opioid prescription use among people with large employer coverage is also higher in the South (16 percent) than in the West (12 percent) or Northeast (11 percent).
"Among people with large employer coverage, the frequency of opioid prescribing increased from 2004 (when 15.7% of enrollees had an opioid prescription) to 2009 (when 17.3% did). After reaching a peak in 2009, the rate of opioid prescribing began to fall. By 2014, the share of people with large employer coverage who received an opioid prescription (15.0%) was lower than it had been a decade earlier, and by 2016, the share was even lower, at 13.6% (a 21% decline since 2009)."

The bottom line from both reports is that spending on addiction treatment is on the rise, and opioid prescriptions are at their lowest levels in a decade. But even if street drugs are the larger problem, prescription opioids are still deeply implicated in the opioid crisis.

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