Substance Use Disorders Cost Employer-Sponsored Health Plans $35B Per Year

Substance use disorders (SUD) cost employer-sponsored health plans about $35.3 billion per year.

That’s according to a new JAMA study, which looked at the cost associated with 162 million non-Medicare eligible members with employer-sponsored health insurance in 2018. Researchers reported that of that 162 million, 2.3 million (1.4%) enrollees had a SUD diagnosis.

The study found that the annual attributable mean cost of SUD per participant was $15,640. Alcohol related-disorders cost employer-sponsored plans $10.2 billion, and opioid-related disorders cost $7.3 billion.

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“The cost of strategies to support employees and their health insurance dependents to prevent and treat SUDs can be considered in terms of potentially offsetting the existing high medical cost of SUDs,” authors of the study wrote. “Medical expenditures for SUDS represent the minimum direct cost that employers and health insurers face because not all people with SUDs have a diagnosis, and costs related to absenteeism, presenteeism, job retention, and mortality are not addressed.”

Researchers also found that 34% of enrollees with a SUD had at least two comorbidities. Depression, hypertension and obesity were the most common comorbidities.

“The $35.3 billion SUD medical cost represents a small fraction of total US personal health care expenditures paid by private insurance ($1.1 trillion in 2018),” authors of the study wrote. “However, in this study, 1% of the ESI population had an SUD diagnosis compared with 11% of workers who self-report SUD, suggesting the medical cost that employers and their health insurance payers face is likely far higher than reported here. Employers can take action by developing workplace supported prevention, treatment, and recovery programs.”

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Rates of SUD have skyrocketed during the COVID-19 pandemic. About 40.3 million Americans have had SUD in the past year, according to a 2020 National Survey of Drug Use and Health (NSDUH).

Behavioral health concerns have long been a concern of health benefits managers. In fact, 20% of all health benefits managers said mental health was a significant concern for their company, according to a managed care health benefits survey by Credit Suisse.

As a result, many point solutions with SUD services have targeted employer-sponsored health plans and other payers. For example, Quit Genius, a digital B2B addiction treatment provider, works with health plans, employers, health systems and individual patients. In July, it announced that it would put 100% of its contract fees at risk.

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