Mental health and substance use disorders are categories of conditions that affect an individual's emotions, thoughts, behaviors, and functioning, often leading to challenges in daily life and relationships. These conditions can result from a mix of genetic, environmental, psychological, and biological factors. Mental health and substance use disorders often interfere with daily functioning and relationships and may require treatment like therapy, medication, or support groups. In the United States, about 1 in 25 adults live with a serious mental illness, such as schizophrenia, bipolar disorder, or major depression. Stigma around mental health and substance use disorders is a significant social issue, creating barriers that prevent people from seeking the help they need. Stigma refers to the negative attitudes, beliefs, and behaviors directed at people due to a particular characteristic, in this case, a mental health or substance use disorder. This stigma can be internalized by the individual or expressed by others, reinforcing harmful stereotypes and discrimination. Stigma may affect access to equitable healthcare; individuals may avoid disclosing their struggles to healthcare providers for fear of judgment or dismissal. As a result, mental health and substance use disorders are often underdiagnosed and untreated, leading to increased morbidity and, in severe cases, mortality. Mental health parity is the principle that mental health and substance use disorder treatment should be covered by health insurance at the same level as physical health conditions. In other words, it ensures that benefits for mental health and substance use disorders are no less comprehensive or affordable than those for other medical conditions.

In the United States, mental health parity was established by laws like:

·        Mental Health Parity Act (MHPA) of 1996: This act was an early attempt to prohibit large group health plans from placing lower annual or lifetime dollar limits on mental health benefits than on medical/surgical benefits. However, it didn’t mandate mental health coverage and had some limitations.

·        Mental Health Parity and Addiction Equity Act (MHPAEA) of 2008: This act strengthened parity requirements by extending protections to include substance use disorders and expanding the scope to cover treatment limits, cost-sharing, and network adequacy. It also applied to large group plans, and later legislation, such as the Affordable Care Act (ACA), expanded its reach to individual and small-group markets.

·        Affordable Care Act (ACA) of 2010: The ACA mandated that all individual and small-group plans must cover mental health and substance use services as essential health benefits and that they must follow MHPAEA’s parity rules.

By providing the same mental health drug benefits that are provided with other health treatments, the burden on seeking mental health care is reduced. This promotes affordability and accessibility, allowing patients to receive the medications needed without facing additional barriers to access.

Enhancing Treatment Adherence

The Mental Health Parity and Addiction Equity Act (MHPAEA) enhances medication adherence for individuals with mental health and substance use disorders by requiring health plans to cover mental health and substance use treatments on equal terms with other medical conditions. This helps people access, afford, and consistently use prescribed medications, which is essential for effective management of their conditions. Here’s how MHPAEA positively impacts medication adherence:

1. Reducing Financial Barriers

Lower Co-Payments and Deductibles: Parity laws require that co-pays, deductibles, and out-of-pocket costs for mental health and substance use medications are comparable to those for other medical conditions. Lowering these financial burdens makes it more feasible for individuals to fill and refill prescriptions regularly.

Affordable Out-of-Pocket Maximums: By capping out-of-pocket expenses at levels similar to those for physical health medications, parity laws prevent people from having to choose between medication and other basic needs, thereby supporting adherence.

2. Ensuring Access to a Full Range of Medications

Comprehensive Medication Coverage: Parity laws mean insurers can’t limit the types of medications available for mental health or substance use more than they do for physical health. Patients, therefore, have access to newer medications that may have fewer side effects or be more effective, improving adherence by reducing unpleasant side effects or complex dosing requirements.

Access to Necessary Treatments: MHPAEA encourages health plans to cover essential medications for mental health and addiction, allowing for a broader range of treatment options that might work better for individuals, enhancing their commitment with prescribed treatments.

3. Reducing Administrative Burdens

Simplified Approval Processes: Insurance plans cannot impose more stringent approval or authorization requirements on mental health medications than on physical health treatments. Simplifying these processes reduces delays in starting or continuing medications, making it easier for patients to adhere to their prescriptions.

Consistent Medication Access: Reduced administrative hurdles, such as imposing medical specialty limitations on mental health drugs, streamline prescription processing, allowing patients to get medications promptly and avoid gaps in their regimen that can disrupt adherence and treatment efficacy.

4. Increasing Provider and Medication Accessibility

Broader Provider Networks: By requiring equal network coverage for mental health services, MHPAEA makes it more likely that people can access in-network providers who can prescribe, adjust, and monitor medications. This continuous support fosters adherence by ensuring prescriptions are appropriate and well-managed.

Support for Integrated Care: Many health plans now support integrated behavioral and physical health services, helping individuals manage mental health conditions and overall health in tandem. Coordinated care improves medication adherence by allowing for close monitoring and adjustment of medications as needed.

5. Promoting Consistency in Treatment

Long-Term Access to Medications: MHPAEA mandates that health plans provide consistent support for mental health treatment, which includes long-term access to necessary medications. Continuous access to effective medications minimizes relapse or symptom recurrence, making it more likely for individuals to adhere to their treatment over time.

Conclusion

By reducing financial burdens, ensuring medication accessibility, and simplifying administrative processes, MHPAEA improves medication adherence for mental health and substance use disorder treatments. Enhanced adherence, in turn, supports better treatment outcomes, including symptom stabilization, relapse prevention, and overall quality of life.



Pharmacy Benefit Managers (PBM’s) work closely with health insurance plans to include multiple treatment options and medical services needed in order to preserve mental health. At MC-Rx, treatments for all disease states are evaluated by a multidisciplinary pharmacy and therapeutics committee. Formulary inclusion processes and utilization management strategies are applied equally and at parity to mental and physical health medications based on clinical, safety and cost effectiveness data. Via the optimal inclusion of mental health treatments in drug formularies, at MCRx, we make sure that the Mental Health Parity and Addiction Equity Act is always applied to pharmacy benefits. At MC-Rx, patients’ wellbeing and mental health is of utmost importance. Medication adherence will ensure the best possible outcomes, this is why it is very important that patients always consult with their pharmacist or physician about how to be adherent and how to keep track of their treatment. To provide the best patient care, MC-Rx promotes educational materials and interventions focused on health and wellbeing, in order to help beneficiaries achieve an excellent quality of life that includes mental health awareness.

References:

1. The Mental Health Parity and Addiction Equity Act (MHPAEA). CMS.gov. (n.d.). https://www.cms.gov/marketplace/private-health-insurance/mental-health-parity-addiction-equity
2. Centers for Disease Control and Prevention. (2023, April 25). About mental health. Centers for Disease Control and Prevention. https://www.cdc.gov/mentalhealth/learn/index.htm
3. Gillotte, A. (2022, December 14). Medication adherence: Why it’s important to patients. Genomind. https://genomind.com/patients/medication-adherence/#:~:text=%E2%80%9CTaking%20your%20medication%20the%20right,end%20up%20in%20the%20hospital.%E2%80%9
4. RefereAcma. (2023, April 19). Understanding the role of the PBM. Prior Authorization Training. https://www.priorauthtraining.org/understanding-the-role-of-the-pbm/#:~:text=PBMs%20are%20responsible%20for%20determining,use%20the%20most%20effective%20treatments.