Health Connector will eliminate copays for addiction treatment

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People fighting addiction who get subsidized insurance will no longer have to pay for outpatient medication and counseling starting next year, a move officials hope will reverberate throughout the insurance market.

The Massachusetts Health Connector, a state agency serving people who don't obtain insurance through an employer, is requiring Connector insurers to eliminate all out-of-pocket costs for medication-assisted treatment that includes drugs such as methadone or Suboxone along with counseling. The Connector's governing board approved the plan unanimously Thursday.

The requirement applies only to health plans that come with federal and state subsidies, which together enroll 169,000 people, a small fraction of the 4.2 million Massachusetts residents who buy commercial insurance.

The Connector developed the requirement for its 2017 plans to bolster the state's campaign against opioid addiction, said Ashley Hague, deputy executive director.

"We were trying to evaluate, 'Is there anything we can do?' " she said. "This seemed like an opportunity that just made sense."

Governor Charlie Baker's Opioid Addiction Working Group had identified copayments as a critical obstacle to treatment for many, Hague said.

Brian Schuetz, director of program and product strategy for the Connector, said the Opioid Addiction Working Group provided feedback on the Connector's plans.

"We really focused on areas where there were gaps that we thought we could fill," he said.

Vic DiGravio, president of the Association for Behavioral Healthcare, welcomed the move.

"That's a really good development," he said. "They deserve a lot of credit for making that decision."

DiGravio said the out-of-pocket costs for counseling, a critical aspect of medication-assisted treatment, are often prohibitive for low-income people. Many methadone patients, for example, have seven counseling sessions a week.

The new rules also eliminate out-of-pocket costs for Narcan and other drugs that reverse overdoses.

Most people who get insurance through the Connector receive a subsidy to help them pay their premiums. Those subsidized plans, called ConnectorCare, don't have deductibles, but they do have copays for some services. The change adopted Thursday eliminates copayments for medication-assisted treatment.

The Connector is also trying to improve access to another addiction service: clinical stabilization services, which are residential programs where people go to continue their recovery after they have finished detox treatment. A 2014 state law requires insurers to cover these services, but patients are not always able to find them close to home.

ConnectorCare plans will now have to make "a good faith effort" to offer a contract to every clinical stabilization service provider in their coverage areas.

Currently, access to these services is inadequate, DiGravio said. In 2015, he said, barely one-fourth of the 22,000 people who underwent detox were able to obtain clinical stabilization services.

Eric Linzer, spokesman for the Massachusetts Association of Health Plans, said insurers' policies on addiction coverage vary. Some have cost-sharing requirements, and others don't. But health insurers are committed to work with the state on ways to tackle the opioid crisis, Linzer said.

The state will share the added expense of eliminating the copayments with the insurers and track the results to see if the program increases access.