Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis.
Schar School of Policy and Government, George Mason University, Fairfax, Virginia.
JAMA Health Forum. 2024 Mar 1;5(3):e240198. doi: 10.1001/jamahealthforum.2024.0198.
On January 1, 2022, New Mexico implemented a No Behavioral Cost-Sharing (NCS) law that eliminated cost-sharing for mental health and substance use disorder (MH/SUD) treatments in plans regulated by the state, potentially reducing a barrier to treatment for MH/SUDs among the commercially insured; however, the outcomes of the law are unknown.
To assess the association of implementation of the NCS with out-of-pocket spending for prescription for drugs primarily used to treat MH/SUDs and monthly volume of dispensed drugs.
DESIGN, SETTINGS, AND PARTICIPANTS: This retrospective cohort study used a difference-in-differences research design to examine trends in outcomes for New Mexico state employees, a population affected by the NCS, compared with federal employees in New Mexico who were unaffected by NCS. Data were collected on prescription drugs for MH/SUDs dispensed per month between January 2021 and June 2022 for New Mexico patients with a New Mexico state employee health plan and New Mexico patients with a federal employee health plan. Data analysis occurred from December 2022 to January 2024.
Enrollment in a state employee health plan or federal health plan.
The primary outcomes were mean patient out-of-pocket spending per dispensed MH/SUD prescription and the monthly volume of dispensed MH/SUD prescriptions per 1000 employees. A difference-in-differences estimation approach was used.
The implementation of the NCS law was associated with a mean (SE) $6.37 ($0.30) reduction (corresponding to an 85.6% decrease) in mean out-of-pocket spending per dispensed MH/SUD medication (95% CI, -$7.00 to -$5.75). The association of implementation of NCS with the volume of prescriptions dispensed was not statistically significant.
These findings suggest that the implementation of the New Mexico NCS law was successful in lowering out-of-pocket spending on prescription medications for MH/SUDs, but that there was no association of NCS with the volume of medications dispensed in the first 6 months after implementation. A key challenge is to identify policies that protect from high out-of-pocket spending while also promoting access to needed care.
2022 年 1 月 1 日，新墨西哥州实施了一项无行为成本分担（NCS）法，取消了该州监管的医疗保险计划中精神健康和物质使用障碍（MH/SUD）治疗的费用分担，这可能会降低商业保险人群中 MH/SUD 治疗的障碍；然而，该法律的结果尚不清楚。
评估实施 NCS 与主要用于治疗 MH/SUD 的药物的自付费用支出和每月药物配药量之间的关联。
设计、设置和参与者：本回顾性队列研究采用差异中的差异研究设计，比较受 NCS 影响的新墨西哥州员工的人群的结果与不受 NCS 影响的新墨西哥州联邦员工的结果。数据收集于 2021 年 1 月至 2022 年 6 月期间新墨西哥州员工健康计划和新墨西哥州联邦员工健康计划的新墨西哥州患者每月 MH/SUD 药物处方的药物。数据分析于 2022 年 12 月至 2024 年 1 月进行。
参加州员工健康计划或联邦健康计划。
主要结果是每位患者开出的 MH/SUD 处方的平均患者自付费用和每 1000 名员工开出的 MH/SUD 处方的每月数量。采用差异中的差异估计方法。
NCS 法的实施与每位患者开出的 MH/SUD 药物的平均（SE）自付费用减少 6.37 美元（0.30 美元）（对应于 85.6%的减少）（95%CI，-7.00 美元至-5.75 美元）相关。实施 NCS 与配药数量之间的关联没有统计学意义。
这些发现表明，新墨西哥州 NCS 法的实施成功降低了 MH/SUD 处方药的自付费用，但在实施后 6 个月内，NCS 与配药量之间没有关联。一个关键挑战是确定既能保护免受高额自付费用又能促进获得所需护理的政策。
