A systematic review published in BMJ Open in December found that surgeries performed for chronic pain conditions were no better than placebo. A December Center for Disease Control (CDC) report found that overdose deaths from opioids continue to escalate rapidly. Opioid abuse deaths now exceed deaths from motor vehicle crashes. More than half a million have died from opioid overdose since 2000. Last July, the FDA strengthened its warning about heart attack and stroke risk from all non-steroidal anti-inflammatory drugs except aspirin, warning against long term use. A 2013 meta-analysis found that spinal steroid injections offered no additional benefit over saline injections. In 2014 the FDA issued a warning that steroid injections into the spine can “result in rare but serious adverse events, including loss of vision, stroke, paralysis, and death. . . . The effectiveness and safety of the drugs for this use have not been established, and the FDA has not approved corticosteroids for such use.”
Clearly, the 116 million Americans who suffer from chronic pain need access to more effective, safer treatments. So why is it that health insurance companies continue to restrict coverage for safer and more effective pain treatments such as chiropractic, biofeedback, acupuncture, physical therapy, exercise programs, psychotherapy, nutritional counseling, low level laser therapy, interdisciplinary pain programs and other proven therapies? Insurance companies do this by various means, including restricting the number of visits in the contract, subjecting such care to pre-authorization and medical necessity reviews which deny care, freezing fees to treatment providers at 35 year old levels or refusing to cover treatment at all.
There ought to be a law, and I am proposing one: the Pain Treatment Parity Act. Its provisions include:
- All pain treatments with some credible evidence of effectiveness must be covered when provided by a licensed or certified provider. This includes any treatments with at least one well-designed randomized, controlled trial showing a significant benefit from the therapy and a good safety profile or any other reasonable evidence of safety and effectiveness. Therapies that currently meet this standard, include chiropractic, physical and occupational therapy, acupuncture, biofeedback, massage therapy, homeopathy, nutritional counseling and supplements, herbal therapy, psychotherapy, energy medicine therapy, supervised exercise programs, and multidisciplinary interventions, including coordination of services.
- There can be no restrictions on the number of treatment visits or length of treatment for nonpharmaceutical pain treatment unless there are similar restrictions on dosage or length of treatment for the preponderance of pharmaceutical treatments for pain.
- Copays for visits to nonphysician pain treatment providers cannot exceed the copayment for primary care physician visits.
- There cannot be a separate deductible for nonphysician pain treatment providers.
- Preauthorization for visits to nonphysician pain treatment providers cannot be required unless preauthorization is required for the preponderance of pharmaceutical treatments for pain.
- Medical necessity reviews cannot occur with greater frequency for nonphysician pain treatment providers than for physicians who provide pharmaceutical treatment for pain.
- Fee schedules for in-network chiropractors, physical therapists, occupational therapists, psychologists, social workers, mental health counselors, acupuncturists, massage therapists, and all other nonphysician pain treatment providers must be increased by the same percentage as the average increase in fees for physicians for all specialties since 1980.
- If an insurance plan has out-of-network benefits for medical and surgical treatments, it must also cover nonphysician out-of-network pain care providers at the same level of reimbursement.
- All medical schools must offer a required course in pain management that educates students about all currently available treatments and the body of evidence supporting their use.
- All physicians who treat chronic pain patients who have not completed a course in pain management in medical school must complete a 12-hour continuing medical education course about the safety and efficacy of all currently available treatments for chronic pain.
The Pain Treatment Parity Act does not yet have state legislative or congressional sponsors or organizations that have officially endorsed it. If you can help with this, please contact me at firstname.lastname@example.org.