October 23, 2018—A new study, published in JAMA Network Open, finds chiropractic care is a widely covered nonpharmacologic approach for chronic low back pain among commercial and government health insurers. An accompanying commentary asserts, however, that continued financial and care coordination barriers associated with these plans may prevent care access and increase opioid usage.
According to the Foundation for Chiropractic Progress (F4CP), a not-for-profit organization dedicated to raising awareness about the value of chiropractic care, these findings validate the need for commercial and public health insurance policies to provide members with incentives to pursue evidence-based, drug-free care for the management of chronic low-back pain.
The study, “Coverage of Nonpharmacologic Treatments for Low Back Pain Among U.S. Public and Private Insurers,” was lead-authored by James Heyward, MPH, a research data analyst at the Johns Hopkins Center for Drug Safety and Effectiveness. Researchers reviewed coverage policies for chronic, non-cancer low-back pain among 45 health plans across 16 states representing more than half of the U.S. population. Interviews were also conducted with 43 medical and pharmacy executives from the health plans.
- Chiropractic care was covered in 89 percent of plans, including all Medicare Advantage plans studied.
- Chiropractic care had no condition requirements among the commercial plans studied, although eight of those 15 plans limited the number of visits.
- Lesser-covered approaches were acupuncture at 33 percent of plans, while only 20 percent of Medicaid plans provided adequate coverage information about psychological interventions.
In an associated commentary on the study, “Insurer Coverage of Nonpharmacological Treatments for Low-Back Pain—Time for a Change,” authors Christine M. Goertz, DC, PhD, and Steven Z. George, PT, PhD, write that financial disincentives along with a lack of coordination among payers concerning nonpharmacologic and pharmacologic therapies may be inhibiting health plan members from pursuing chiropractic care. Authors cited a Gallup-Palmer College of Chiropractic report that showed 78 percent of Americans would prefer a non-pharmacological treatment for pain before considering an opioid.
“While it is encouraging chiropractic care and other drug-free care options are widely covered by both commercial and public payers for chronic low back pain, unfortunately, more must be done to assure consumers will choose non-pharmacologic approaches such as chiropractic care before resorting to short-sighted options, such as NSAIDS and opioids. This puts them at risk for long-term adverse side-effects including misuse, abuse and overdose,” said Sherry McAllister, DC, executive vice president, F4CP. “In light of the recently passed federal opioid legislation, doctors of chiropractic look forward to working with the Centers for Medicare and Medicaid Services to design new policies to make our evidence-based, effective and preferred drug-free care for chronic pain more affordable and accessible for beneficiaries.”
Heyward J, Jones CM, Compton WM, et al. Coverage of Nonpharmacologic Treatments for Low Back Pain Among US Public and Private Insurers. JAMA Network Open. 2018;1(6):e183044. doi:10.1001/jamanetworkopen.2018.3044.