Deep in the throes of the US opioid epidemic, Illinois and its Department of Insurance have formally requested that the federal Centers for Medicare & Medicaid Services (CMS) add coverage requirements for substance abuse prevention and treatment to Affordable Care Act programs operating within that state.

As more attention is being given to the role that social determinants of health (SDOH) play in public health outcomes and overall healthcare expenditure, some experts believe that providing such coverages could be the most cost-effective, outcome-improving play.

Illinois insurance regulators requested that CMS limit ACA plans’ prescription coverage of opioid medications to 7-day courses, when prescribed for cases of acute pain. They also requested that CMS require coverage for nasal spray naloxone (Narcan).

In addition, Illinois asked CMS to cover telepsychiatry services for addiction counseling and mental health diagnoses, and alternative pain management therapies.

The request comes after the Trump administration ruled that states can request changes to required ACA coverages and, if approved, would increase premiums by an average of 30 cents per month, according to state projections.

Read more in this Chicago Tribune article by Lisa Schencker.