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Update to New Substance Abuse Treatment Coverage

As previously mentioned in our July 2015 Special Edition IAI, we have made changes to our substance abuse treatment coverage for many of our commercial (insured and self-funded), Medex, and Managed Blue for Seniors health plans.

At the time of publication, the Division of Insurance (DOI) had not yet provided guidance. Having received guidance from the DOI, we have made the appropriate updates to our health plans.

As a reminder, effective on 10/1/2015, we provide coverage for:

  • Medically necessary acute treatment and clinical stabilization services for up to 14 days, without requiring preauthorization prior to obtaining treatment, when the services are provided by providers in Massachusetts. Services administered by providers outside of Massachusetts will continue to be subject to preauthorization.
  • Other substance abuse treatment services, without requiring the member to obtain preauthorization before obtaining treatment, if the service is provided by providers in Massachusetts.
  • Services provided by licensed alcohol and drug counselors.
  • Access to abuse-deterrent opioid drugs that is not less favorable than non-abuse deterrent opioids. Although the Department of Public Health has not yet published the finalized drug formulary, we anticipate minimal impact since these drugs may already be on our formulary.

For more information, please contact your account executive.

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