Payer Policies May Discourage Non-Pharma Tx for Low Back Pain

Physical therapy, psychological counseling, other alternatives not consistently covered.
Physical therapy, psychological counseling, other alternatives not consistently covered.

HealthDay News — There is a need for public and private insurers to broaden their coverage policies for non-drug pain treatments for low back pain, according to a study published online October 5 in JAMA Network Open.

James Heyward, MPH, from the Johns Hopkins Bloomberg School of Public Health in Baltimore, and colleagues examined coverage policies for non-pharmacologic approaches commonly used to treat acute or chronic low back pain among 15 commercial, 15 Medicaid, and 15 Medicare Advantage health plans. Interviews were conducted with 43 senior medical and pharmacy health plan executives representing the plans (6 Medicaid managed care organizations, two Medicare Advantage or Part D plans, nine commercial plans, and three trade organizations). 

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The researchers found that payers most commonly covered physical therapy (98% [44 of 45 plans]), occupational therapy (96% [43 of 45 plans]), and chiropractic care (89% [40 of 45 plans]). Among the therapies examined for Medicaid plans only, transcutaneous electrical nerve stimulation (67% [10 of 15 plans]) and steroid injections (60% [9 of 15 plans]) were most commonly covered. Despite evidence to support their use, 67% of all plans (30 of 45) did not cover acupuncture and 12 of 15 Medicaid plans lacked information about coverage of psychological interventions. Utilization management tools (e.g., prior authorization) were common, but criteria varied greatly for quantity and duration of services covered.

"Wide variation in coverage of nonpharmacologic treatments for low back pain may be driven by the absence of best practices, the administrative complexities of developing and revising coverage policies, and payers' economic incentives," the authors write.

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