Association for Public Policy Analysis & Management

Drug overdose deaths in America exceeded 50,000 in 2015, claiming more lives annually than gun and motor vehicle accidents since 2009. Of these, more than 33,000 overdose deaths were due to opioids (NIH, 2017). These numbers are the culmination of an upward trend in opioid-related morbidity and mortality that has occurred over the past two decades. While opioid agonist therapy is regarded as the most effective treatment for opioid use disorders (National Consensus Development Panel on Effective Medical Treatment of Opiate Addiction, 1998), recent figures shows that a relatively low number of patients receive it (Volkow, 2014). Health insurance parity laws and regulations, like the Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA), could help increase the adoption and implementation of medication-assisted treatment (MAT) for OUD. Could broad insurance parity requirements for addiction of MHPAEA lead to an increase in access to the most effective medication for opioid use disorder treatment? This paper addresses the gap in research by evaluating MHPAEA’s implementation on access to and cost burden of MAT, specifically buprenorphine. I use a random sample of 5,000 physicians from a commercial pharmacy database of prescription transactions at the retail level in five U.S. states to examine the effect of the federal parity law on the amount of buprenorphine supplied and on the costs to patients and insurers (i.e., payer groups) before and after MHPAEA’s Interim Final Rule implementation in states with no previous parity laws relative to those with pre-existing SUD parity laws. I find that the federal parity law for substance use disorders did not increase access to buprenorphine, measured by standard doses per month, and did not decrease medication costs for patients or payer groups. While I find an overall increase in buprenorphine purchased in all five states and all payer groups, this increase is not associated with parity. State and federal policies that aim to expand treatment and improve patient outcomes for people with OUD may not achieve so through parity laws, at least in their current form. Insurance parity regulations that do not explicitly mandate coverage for opioid use disorders may not be enough to increase access to treatment. Furthermore, implementation and evaluation of these policies should be prioritized by policymakers if parity is to remain a pillar of future health policies.