New Bulletin Addresses Coverage Guidelines for Pain Management Alternatives to Opiate Products

On August 29, 2019, the Division of Insurance published Bulletin 2019-06, which provides coverage guidelines for pain management alternatives to opiate products. According to the bulletin, the Division expects carriers to take all appropriate steps to ensure that fully insured plans make coverage for methods other than opiate treatment available to covered persons to manage pain. Specifically, the plan must provide at least two alternative medication treatment options and at least three alternative non-medication treatment modalities. Such alternatives may include other types of prescriptions, supplies, services or treatments that the carrier may determine are appropriate for covered individuals.

Carriers must also make appropriate updates to drug formularies and network directories, so as to make access to such treatment options readily available to covered persons. Also, carriers that identify an alternative method that involves coverage for services provided by specific types of providers (such as massage therapists, acupuncturists, and/or chiropractors) will be required to contract with a sufficient number of providers to have the alternative services available throughout the carrier’s service area.

There are no new employer obligations under the new bulletin, but employers with fully insured plans in Massachusetts should be aware of the coverage requirements.

Bulletin 2019-06 »