May is recognized as Mental Health Awareness Month in the United States to raise awareness of mental illness and advocate for improvements in mental health care. Exacerbated by pandemic restrictions over the past two years, mental health issues are affecting a growing proportion of Americans and include mental, behavioral and emotional disorders, the effects of which can range from mild to severe impairment on an individual’s daily life. Centers for Disease Control and Prevention estimates that approximately one in five Americans suffers from a mental illness in any given year, and the National Institute of Mental Health suggests the prevalence may be even higher in adolescents.

Despite federal law requiring parity between mental and physical health care (more on this below), a January 2022 report by the Departments of Labor, Health and Human Services, and Treasury found in initial determinations that one-third of all health insurance plans and issuers analyzed did not comply with applicable law. Additionally, in 2020, nearly a quarter (24.7%) of adults with mental illness reported an unmet need for treatment. So what exactly is the existing mental health parity law, and why doesn’t it seem to be working?

Adopted in 2008 and implemented in 2013, the Mental Health Parity and Addiction Equity Act (MHPAEA) requires insurers to cover “diseases of the brain no more restrictively than diseases of the body,” although it does not require health plans to provide coverage for mental health or treatments for mental disorders. substance use. In other words, if a plan provides benefits for mental health or substance abuse disorders, the benefits must not be less restrictive than other health benefits included in the plan in terms of treatment limits, availability of suppliers, physician referrals and payment amounts, among others. things. Most group and individual health insurance plans are subject to federal parity requirements under current law as amended by the Affordable Care Act (ACA), including most employer-sponsored group plans , individual plans in the ACA market, Medicaid managed care organizations, and the Children’s Health Insurance Program. Medicare, Medicaid fee-for-service plans, and small self-insured group plans are some of the few exceptions.

While the goals of mental health parity laws are simple in theory, they are complicated in practice and have historically been difficult to enforce. Prior to 2021, plans and issuers were not required to document parity compliance, making it difficult for law enforcement agencies, such as the Employee Benefits Security Administration. (EBSA), which oversees more than 2 million private employment-based group health plans covering approximately 137 million people. Americans, or the Centers for Medicare and Medicaid Services (CMS) which has authority over non-federal government plans in all states and fully insured individual and group plans in Texas, Missouri and Wyoming, to ensure that beneficiaries are properly covered.

the Consolidated Appropriation Act of 2021 facilitated the enforcement of parity requirements by requiring that plans covering treatment for mental health and substance use disorders prepare and document comparative analyzes of all non-quantitative treatment limits, such as requirements prior authorization or step therapy protocols by February 2021. According to the January 2022 report, however, none of the 171 responding regimes or issuers had completed sufficient benchmarking by that deadline. Even after obtaining sufficient information, EBSA and CMS issued initial decisions of non-compliance for a third of respondents. Of the responding plans and issuers, the most common parity violations involved the exclusion of applied behavior analysis therapy to treat autism spectrum disorders and the requirement for licensed mental health or addictions providers to bill the scheme only through specific types of other providers. For their part, insurers cite the lack of detailed guidance from federal agencies as a major challenge to being deemed fully compliant with testing requirements.

More than a decade after the MHPAEA began requiring mental health parity from insurers, its requirements have not been fully implemented. Whatever the challenges, the COVID-19 pandemic has certainly reminded us that mental and physical health are linked and underscored the need for better coordination to fully achieve mental health parity.

Chart Review: Retail Prescription Drug Spending and 340B

Jackson Hammond, Health Care Policy Analyst

The best Medicaid price (MBP) The rule was created in 1990 as part of the Medicaid Drug Rebate Program (MDRP), which attempted to control government prescription drug costs. MDRPs subsequent effect on eliminate charitable donations drug manufacturers to hospitals leads to the creation in 1992 340B Drug Pricing Program (340B), in an effort to “stretch federal dollars” as much as possible by saving hospitals money on drug costs. The program has grown considerably since its inception, especially in the last decade since Affordable Care Act passed. Using data from the Peterson-KFF Health System Trackingyouhe table below examines the correlation between per capita retail spending on prescription drugs and the introduction and expansion of the MDRP and 340B program, with particular emphasis on the 340B program. As the graph shows, there are noticeable, and in some cases significant, increases in the expense rate as a resultand implementation of these successive Strategies. The Human Resources and Services Administration (HRSA) issued a rule in 1996 allowing hospitals and other 340B participating entities to use only one contract pharmacy per entity to provide patients with 340B discounted drugs. In 2010, the HRSA issued new regulations allowing 340B entities to use an unlimited number of contract pharmacies.s. In any case, after a period of adaptation to the most recent rule, the expenses further increasedespecially after the 2010 expansion. drug pricing is complexmany factors influencing price, it is worth consider whether MBP and 340B have unexpected retail expenses impact.

Data Source: Peterson-KFF Health System Tracker