Press Release  HPC RELEASES TWO NEW STUDIES ON BEHAVIORAL HEALTH CARE TREATMENT ACCESS, PRESCRIPTION DRUG AFFORDABILITY

Boston — Today, the Massachusetts Health Policy Commission (HPC) issued two new publications – Co-Occurring Disorders Care in Massachusetts: A Report on the Statewide Availability of Health Care Providers Serving Patients with Co-Occurring Substance Use Disorder and Mental Illness and a new DataPoints issue (#11) on insulin price growth and patient out-of-pocket spending. The findings were presented at the May 1, 2019, meeting of the HPC’s Board, at which commissioners discussed the analyses and potential policy impacts.

The findings and policy recommendations released today highlight unique access and affordability challenges faced by many patients in the Commonwealth seeking necessary health care services.

New Report: Co-Occurring Disorders Care in Massachusetts: A Report on the Statewide Availability of Health Care Providers Serving Patients with Co-Occurring Substance Use Disorder and Mental Illness

In 2016, the state Legislature charged the HPC with assessing the availability and capacity of providers treating patients with “dual diagnoses” of mental illness and substance use disorder (SUD), or co-occurring disorders. Nationally, co-occurring disorders affect 18 percent of adults with mental illness and 43 percent of adults with SUD. In Massachusetts in 2016, approximately 20 percent of adults reported past year mental illness and 10 percent reported past year SUD.

“While the Commonwealth has made notable progress in strengthening access to mental health and substance use disorder treatment, the report released today highlights the importance of maintaining this commitment moving forward and for further advancing the integration of treatment for all patients with co-occurring mental illness and substance use disorder,” said Marty Cohen, HPC Commissioner and President and CEO of the MetroWest Health Foundation. “As with our response to the opioid epidemic, Massachusetts can be a national leader in ensuring that these vulnerable patients have access to high-quality, coordinated care in the most appropriate setting.”

The legislation tasked the HPC with creating an inventory of health care providers capable of treating patients with dual diagnoses, which includes the location and nature of services offered at each such provider, an assessment of the sufficiency of and barriers to treatment, including factors such as geographic barriers to access and insurance coverage, and recommendations for reducing those barriers to care. The map of licensed facilities is displayed interactively on the HPC’s website. The HPC released key findings (slides 30-53) from the report in November, and today released the final report with the following policy recommendations:

1. Evidence-Based Integrated Care Models: The Commonwealth should continue to promote and fund evidence-based integrated care models for the treatment of co-occurring disorders, particularly those that integrate care with community based organizations, primary care providers, and social service organizations.
2. Behavioral Health Medication Treatment: The Commonwealth should strengthen access to behavioral health medication treatment and recognize it as a standard of care. Additionally, the Commonwealth should promote and support access to prescribers through telemedicine, memoranda of understanding, or innovative models that offer both medication and other interventions.
3. Data About Patients and Providers: Efforts should be made to prioritize data collection on demographics and health outcomes of patients with co-occurring disorders, and on the availability of providers offering integrated, evidence-based treatment.
4. Behavioral Health Workforce: The Commonwealth should continue to invest in developing a diverse, well-trained, and supported behavioral health workforce by improving both the number and training of clinicians available and prepared to care for diverse populations with co-occurring disorders.
5. Streamlining the Licensure Process: The Commonwealth should continue its ongoing efforts to streamline licensure and reduce administrative burden for behavioral health clinics and facilities to help improve access to integrated care for co-occurring disorders and promote high-quality standards of care.
6. Payment Policies: Payers should improve reimbursement rates and payment policies that limit access to mental health and substance use disorder services and communicate these policies clearly to providers.

DataPoints Issue #11: Insulin Price Growth and Patient Out-of-Pocket Spending

The HPC today released the eleventh issue of its DataPoints series, which examines spending trends from 2013 to 2016 for commercially insured patients who have diabetes and use insulin to manage their condition. In recent years, the growth in prescription drug spending has outpaced almost every other category of spending growth — and the state’s health care cost growth benchmark. While this cost growth is affecting residents with many different health conditions, the price increase for insulin and its impact on patients with diabetes has been particularly concerning. Patients who use insulin must receive regular injections to keep their blood sugar at safe levels. National studies show substantial growth in prices for insulin in recent years, with high costs leading some patients to ration insulin.

“With regard to pharmaceutical affordability, we found a significant increase in insulin drug prices in recent years that is both striking and troubling, contributing to higher out-of-pocket spending for thousands of Massachusetts patients with diabetes,” said David Seltz, HPC Executive Director. “The HPC continues to recommend that policymakers consider new reforms and strategies necessary to reduce drug spending growth in the Commonwealth.”

At the annual Health Care Cost Growth Benchmark Hearing held on March 13, 2019, the HPC released select findings (slides 29-32) on the rising price of insulin, and today released an expanded analysis with further findings and interactive graphics.

Key findings include:

• Annual health care spending increased from $13,045 in 2013 to $17,061 in 2016 for individuals who have diabetes and use insulin to manage their condition. Annual spending on insulin for this population increased by 50 percent from $3,122 in 2013 to $4,684 in 2016, accounting for 39 percent of the total spending increase.
• By 2016, spending on insulin represented the largest component of total health care spending for individuals who have diabetes and use insulin to manage their condition.
• The mean price per unit of insulin across all products increased from 15 cents in 2013 to 23 cents in 2016, while average daily use across all insulin products remained consistent at 59 units of insulin per person per day.
• Rising costs of prescriptions for medical management of diabetes threaten access to and affordability of evidence-based care, and may lead to unnecessary complications and avoidable hospitalizations. High insulin prices particularly impact lower-income commercially insured patients.
• In 2016, the average out-of-pocket spending for insulin among commercially insured patients was $28 per month ($340 per year), and 18 percent of patients paid more than $500 per year. Five percent of the study population experienced substantially higher out-of-pocket insulin costs of $96 per month on average ($1,156 per year).
• The percentage of income spent on out-of-pocket health care costs varied from 1.8 percent ($1,859 in total annual out-of-pocket spending) in West Merrimack/Middlesex to 3.4 percent ($1,938 in total annual out-of-pocket spending) in Fall River.
• Insulin-specific out-of-pocket spending was lowest in the Berkshires ($307 annually) and highest in Norwood/Attleboro ($364 annually).

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