Bonakdar Robert, Palanker Dania, Sweeney Megan M
Scripps Center for Integrative Medicine, La Jolla, California.
Center on Health Insurance Reforms, Health Policy Institute at Georgetown University, Washington, District of Columbia.
Glob Adv Health Med. 2019 Jul 29;8:2164956119855629. doi: 10.1177/2164956119855629. eCollection 2019.
In 2017, the American College of Physicians (ACP) released guidelines encouraging nonpharmacologic treatment of chronic low back pain (LBP). These guidelines recommended utilization of treatments including multidisciplinary rehabilitation, acupuncture, mindfulness-based stress reduction (MBSR), tai chi, yoga, progressive relaxation, biofeedback, cognitive behavioral therapy (CBT), and spinal manipulation.
We aimed to determine status of insurance coverage status for multiple nonpharmacological pain therapies based on the 2017 Essential Health Benefits (EHB) benchmark plans across all states.
The 2017 EHB benchmark plans represent the minimum benefits required in all new policies in the individual and small group health insurance markets and were reviewed for coverage of treatments for LBP recommended by the ACP guidelines. Additionally, plans were reviewed for limitations and exclusionary criteria.
In nearly all state-based coverage policies, chronic pain management and multidisciplinary rehabilitation were not addressed. Coverage was most extensive (supported by 46 states) for spinal manipulation. Acupuncture, massage, and biofeedback were each covered by fewer than 10 states, while MBSR, tai chi, and yoga were not covered by any states. Behavioral health treatment (CBT and biofeedback) coverage was often covered solely for mental health diagnoses, although excluded for treating LBP.
Other than spinal manipulation, evidence-based, nonpharmacological therapies recommended by the 2017 ACP guidelines were routinely excluded from EHB benchmark plans. Insurance coverage discourages multidisciplinary rehabilitation for chronic pain management by providing ambiguous guidelines, restricting ongoing treatments, and excluding behavioral or complementary therapy despite a cohesive evidence base. Better EHB plan coverage of nondrug therapies may be a strategy to mitigate the opioid crisis. Recommendations that reflect current research-based findings are provided to update chronic pain policy statements.
2017年，美国医师协会（ACP）发布指南，鼓励对慢性下腰痛（LBP）进行非药物治疗。这些指南建议采用多种治疗方法，包括多学科康复、针灸、基于正念的减压疗法（MBSR）、太极拳、瑜伽、渐进性放松、生物反馈、认知行为疗法（CBT）以及脊柱推拿。
我们旨在根据2017年所有州的基本健康福利（EHB）基准计划，确定多种非药物疼痛治疗的保险覆盖情况。
2017年EHB基准计划代表了个人和小团体医疗保险市场所有新政策所需的最低福利，并对ACP指南推荐的LBP治疗覆盖情况进行了审查。此外，还对计划的限制和排除标准进行了审查。
在几乎所有基于州的保险政策中，慢性疼痛管理和多学科康复均未涉及。脊柱推拿的覆盖范围最广（46个州支持）。针灸、按摩和生物反馈的覆盖州均少于10个，而MBSR、太极拳和瑜伽则没有任何一个州提供覆盖。行为健康治疗（CBT和生物反馈）通常仅涵盖心理健康诊断，尽管被排除用于治疗LBP。
除脊柱推拿外，2017年ACP指南推荐的循证非药物疗法通常被排除在EHB基准计划之外。保险覆盖通过提供模糊的指南、限制持续治疗以及排除行为或辅助疗法，尽管有连贯的证据基础，但却不利于慢性疼痛管理的多学科康复。更好地在EHB计划中覆盖非药物疗法可能是缓解阿片类药物危机的一种策略。提供了反映当前基于研究结果的建议，以更新慢性疼痛政策声明。
