Does the Passing of a No Behavioral Health-Cost Sharing Law Have Any Bearing on Spending?

Image Credit: Adobe Stock Images/ShubbyStudio.com

In the United States, one of several public health obstacles is the underuse of care for mental health and substance use disorder (MH/SUD). Unfortunately, some of those experiencing MH/SUD find themselves delaying care due to either a shortage of clinicians or the stigma surrounding mental health. Out-of-pocket (OOP) expenses due to cost-sharing is another barrier.

Due to these challenges, in April 2021, New Mexico passed SB 317, known as the No Behavioral Health Cost Sharing (NCS) into law, which bans cost-sharing for MH/SUD treatment— including for prescription meds—for people with commercial insurance plans. The law went into effect Jan. 1, 2022.

Being that the outcomes of the law were unknown at this point, a cohort study published in JAMA Health Forum¹ explored NCS’ impact on dispensed psychotropic medications by focusing on people who were enrolled in New Mexico’s state employee health plans versus New Mexico residents who enrolled in federal employee plans, which are not covered by the NCS. The main outcomes were the mean nominal patient OOP spending on MH/SUDs, along with the monthly volume of dispensed medications that are mainly used for MH/SUDs, such as antipsychotics, anxiolytics, mood stabilizers, opioid antagonists, medications for drug and alcohol dependence, and others.

The study used data from the 2021 to 2022 IQVIA Longitudinal Prescription Claims Database, which consists of approximately 90% of US-filled prescriptions, and 60% to 85% of those filled by mail-order pharmacies. Prescription-level data was divided by treatment/comparison group and drug class.

Being that the data was observational, the investigators conducted the study using a difference-in-differences estimation technique. Linear regression models were also produced to display results of the study, and were based on three independent variables:

1. To determine whether an observation was noted after NCS implementation in January 2022.
2. To figure out whether an observation was in the treatment group or comparison group.
3. To document the interaction between being in the treatment group and being after the implementation of NCS.

Overall, it featured a total of 47,229 participants (mean [SD] age 49.0 [19.6] years), with 21,626 individuals being prescribed a total of 176,762 MH/SUD drugs in the treatment group and 25,669 individuals being prescribed 156,502 MH/SUD drugs in the comparison group.

As a result of the NCS law being passed, there was a mean (SE) $6.37 ($0.30) reduction (corresponding to an 85.6% decrease) in mean OOP spending per dispensed MH/SUD medication (95% CI, −$7.00 to −$5.75). The association of implementation of NCS with the volume of prescriptions dispensed was also not deemed statistically significant.

Therefore, the study authors concluded that, “… in the 6 months after New Mexico prohibited cost-sharing for MH/SUD treatment for state regulated commercial insurance plans, mean OOP spending for medications used to treat MH/SUDs declined. However, we also found no evidence of an association of NCS with the overall volume of dispensed MH/SUD prescription drugs in the first 6 months after the law was implemented. While our preliminary data suggest the law may have been successful in its goals of improving MH/SUD treatment affordability, the longer-term and broader effects of this law, such as on nonpharmaceutical services, remain to be seen. Nevertheless, the law may reduce the burden of psychotropic medication [OOP] expenses even in its first months of implementation, and potentially may help address the ongoing challenge of ensuring that financial barriers do not limit access to and quality of care for treatment of MH and SUDs.”

Reference

1. Golberstein E, Campbell JM, Maclean JC, Harris SJ, Saloner B, Stein BD. Prescription Drug Dispensing and Patient Costs After Implementation of a No Behavioral Health Cost-Sharing Law. JAMA Health Forum. 2024;5(3):e240198. doi:10.1001/jamahealthforum.2024.0198