Coverage of Nondrug Treatments for Back Pain Inconsistent Across Insurers

Although most insurers tend to cover physical and occupational therapy as well as chiropractic care for the treatment of chronic low back pain, coverage for acupuncture and psychological interventions is less consistent despite evidence supporting their use. Researchers published their findings in JAMA Network Open.

“These findings are important,” researchers wrote, “given the growing literature indicating that nonpharmacologic treatments for chronic, noncancer pain can reduce opioid exposure and overuse and improve patients’ quality of care and pain control.”

The large-scale assessment of coverage policies for nonpharmacologic treatments for low back pain included a representative sample of 15 commercial, 15 Medicaid, and 15 Medicare Advantage health plans.

Among them, 98% covered physical therapy, 96% covered occupational therapy, and 89% covered chiropractic care, researchers reported. However, 67% of plans did not cover acupuncture, and 80% of Medicaid plans lacked information about coverage for psychological interventions.

Furthermore, prior authorization, visit limits, and other utilization management tools were common. Researchers also reported wide variations as to the quantity and duration of services covered.

“Given recommendations in recent clinical practice guidelines that prioritize nonopioid treatments, including nonpharmacological treatments, as first-line therapy for many types of chronic pain, including low back pain, our findings highlight a number of opportunities across a broad range of public and private payers to improve coverage and reimbursement policies for nonpharmacological treatments for pain,” researchers wrote.—Jolynn Tumolo