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Anthem easing access to MAT and counseling services

January 25, 2017
by Tom Valentino, Senior Editor
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Health insurer Anthem recognizes the combination of behavioral health counseling and drug therapy as a best practice for substance use disorder treatment. There’s just one problem: The insurer’s internal research found that fewer than 1 in 5 members receiving medication-assisted treatment (MAT) have also been receiving counseling.

To that end, Anthem has announced changes that will enhance reimbursement to providers of MAT services and double the number of members who receive behavioral health counseling as part of their drug therapy for opioid addiction.

“It says it all in that title: It’s medication-assisted therapy,” Sherry Dubester, MD, Anthem’s vice president of behavioral health and clinical programs, tells Behavioral Healthcare Executive. “We want to make sure we do what we can to increase access to both to the medication and to the supporting services.”

Between 16% and 19% of Anthem plan members receiving buprenorphine products to treat opioid use disorder were also receiving in-person counseling, according to Anthem research. The plan changes that will aim to double that figure were first tested with three Anthem affiliated plans in the Northeast in 2016 and are slated to be extended to all Anthem health plans by early 2018.

Concurrently, Anthem announced it is also discontinuing its preauthorization requirement for medication-assisted treatment drugs, as part of a settlement with the New York attorney general’s office. The change applies to its plans nationwide.

Dubester says the “New York attorney general’s input was consistent” with the insurer’s internal research in making the decision. The preauthorization requirement was originally put in place to ensure clinically appropriate use and combat medication diversion. The risk for diversion still exists, Dubester says, but is viewed by Anthem “to be less of a concern and less of a trend than a few years ago.”