About 1-in-4 Americans accessed behavioral health care through employer-provided coverage in 2020.

This data — from a new report by AHIP’s Coverage@Work — highlights the bounds of company health plans in providing access to in-network and potentially more affordable behavioral health services. In total, the report highlighted the health care engagement of 41 million Americans, including 6 million children.

The research behind the report comes from an analysis of medical and pharmacy claims data from the IBM MarketScan Commercial Database for the period Jan. 1, 2016, to Dec. 31, 2020. 

The analysis looked at billing codes for common disorders such as ADHD, anxiety, bipolar disorder, depression, schizophrenia, and opioid- and alcohol-related substance abuse.

About 22 million people — more than half the patients who received behavioral health support — received them from a primary care provider, including pediatricians. 

About 13 million received support from individual and group psychotherapy.

“Psychiatrists, psychologists, licensed clinical social workers, and therapists offer valuable, specialized support, while PCPs offer a holistic approach for physical and mental health support, from anxiety and depression, to medication and comprehensive care for more complex conditions,” the report states.

Patients clocked in at an average of three behavioral health-related visits per year with a primary care provider and an average of 10 psychotherapy sessions in 2020. 

The report specifically delves into the rise of telehealth and its role in facilitating behavioral health treatment.

Telehealth visits encompassed a tiny portion of psychotherapy sessions and primary care provider visits in 2016, 2017, 2018 and 2019. In 2019, telehealth facilitated 0.39% of psychotherapy sessions and 0.5% of primary care provider visits. In 2020, the first year of the pandemic, the share of telehealth visits increased to 39.4% for psychotherapy — a 100x increase — and 30.1% for primary care visits — a 60x increase.

The report also finds that most (80%) of behavioral health-related prescriptions come in a generic form and at a lower cost than name-brand medications.

“This means these treatments are affordable for the patients who need them,” the report states. “The average out-of-pocket costs per prescription for brand drugs with no generic alternatives to treat mental health conditions were about $100, compared with less than $15 for generics.”

Public health plans backed by the federal and state governments round out most of the spending on behavioral health services. Medicaid, the safety-net health plan, accounts for an estimated 30% of all spending on behavioral health services.

However, millions could be at risk of losing coverage in the wind-down period following the end of the public health emergency. 

In total, the U.S. saw an estimated $280.5 billion spent on behavioral health, according to a Substance Abuse and Mental Health Services Administration analysis — about $179.4 billion (64%) came from public health plans including Medicare, the federal health plan for seniors, and Medicaid while $101.1 billion (36%) came from private sources including out-of-pocket payments and private health insurance.