The Effects of Federal Parity on Substance Use Disorder Treatment | Page 3

Published Online: January 23, 2014
Susan H. Busch, PhD; Andrew J. Epstein, PhD; Michael O. Harhay, MPH; David A. Fiellin, MD; Hyong Un, MD; Deane Leader Jr, DBA, MBA; and Colleen L. Barry, PhD, MPP
Another limitation is that MHPAEA may lead to multiple insurance market changes, including declines in the out-ofpocket price of services, increases in supply-side constraints imposed by insurers (ie, prior authorization, referral restrictions), and reduced stigma associated with SUD treatment, which may all affect use and spending. Although our study design allowed us to determine the net effect of parity, we were not able to disentangle these competing mechanisms.

A third consideration is that preexisting state parity laws were not identical to MHPAEA; therefore, fully insured enrollees in our comparison group might have experienced some change in benefits as they moved from being subject to the less comprehensive state parity laws to the more comprehensive MHPAEA in 2010. A fourth limitation is that we did not consider changes in costs for treatment of substance abuse–related medical conditions (eg, alcoholic cirrhosis, hepatitis). A fifth limitation relates to the generalizability of our findings. We evaluated the effects of parity on individuals insured by a single health insurer in 10 states with preexisting state SUD parity laws. Thus our results may not be generalizable to other insurance or population contexts.

Finally, this study examined only the first year after MHPAEA took effect. The interim final regulations of MHPAEA, which were released in February 2010 and took effect for most plans in 2011, prohibited plans from using so-called nonquantitative treatment limits for mental health and SUD benefits unless these limits were comparable to those used for general medical services.24 Nonquantitative treatment limits include medical management standards, prior authorization, utilization review, prescription drug formulary design, standards for provider admission to participate in a network, and provider reimbursement. It is possible that these regulations could lead to different effects of the law; therefore, it is critical for future research to examine use and spending in response to MHPAEA in subsequent years.

Take-Away Points

Federal parity, as implemented in 2010, is unlikely to lead to large increases in total healthcare spending. 
  • In 1 national health plan, federal parity led to a small increase in spending on substance use disorder treatment per enrollee ($9.99, 95% confidence interval, 2.54-18.21) in 2010, the first year after the policy took effect.
  • This increase was not due to more individuals initiating treatment.
  • Future work should consider the effects of the law in subsequent years after regulations affecting the management of care (eg, utilization review, network access) take effect
Author Affiliations: From Perelman School of Medicine, University of Pennsylvania (AJE, MOH), Philadelphia, PA; Yale School of Public Health (SHB, DAF), New Haven, CT; Yale School of Medicine (DAF), New Haven, CT; Aetna (HU, DL), Hartford, CT; John Hopkins Bloomberg School of Public Health (CLB), Baltimore, MD.

Funding Source: This study was funded by the National Institute on Drug Abuse (grant DA 026414).

Author Disclosures: The authors report no relationship or financial interest with any entity that would pose a conflict of interest with the subject matter of this article.

Authorship Information: Concept and design (SHB, AJE, DAF, CLB); acquisition of data (SHB, DL, CLB); analysis and interpretation of data (SHB, AJE, MOH, DAF, HU, DL, CLB); drafting of the manuscript (SHB, CLB); critical revision of the manuscript for important intellectual content (SHB, AJE, MOH, DAF, HU, DL, CLB); statistical analysis (SHB, AJE, MOH, CLB); obtaining funding (SHB, DAF, CLB), administrative, technical, or logistic support (SHB, AJE, MOH, DL, CLB); and supervision (SHB, CLB).

Address correspondence to: Susan H. Busch, PhD, Yale School of Public Health, 60 College St, New Haven CT 06520-8034.
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