Medicare and Acupuncture Coverage
The biggest news to hit the stands in recent months was the proposal of Medicare to potentially cover acupuncture for chronic low back pain in the coming year. A news article on CMS.gov from July 15, 2019 spoke to why acupuncture coverage may be a reasonable and necessary treatment option under Medicare.
The Centers for Medicare and Medicaid state that they are actively working with the National Institutes of Health (NIH) launching studies on acupuncture for the treatment of chronic low back pain in adults 65 years and older as this is a leading reason for opioid prescribing in older patients. Being that acupuncture provides natural opioid to the body when needles are inserted at the proper acupuncture points, this proposal is one that has everyone’s attention.
What is Chronic pain?
Chronic pain is defined as pain that lasts 12 weeks or more. Health care providers have overused powerful painkillers to address chronic pain with little research to support it, along with a host of unwanted side effects. Acupuncture continues to gain legitimacy in the treatment of chronic pain. Pain relief from acupuncture comes from:
- inactivating the source of pain by releasing endorphins and,
- triggers the release of natural opioid, serotonin, a chemical involved with mood, therefore alleviating the awareness of pain.
Basically, acupuncture activates your own body’s built-in healing properties. A study in 2012 showed acupuncture as an effective treatment option, highlighting the significant differences between true acupuncture and sham acupuncture, thus indicating acupuncture is much more than just a placebo. Acupuncture treatments for pain may require 6-12 sessions over a 3-month period and potentially regularly for pain management.
Will Medicare Cover Acupuncture in 2020?
The jury is still out on whether Medicare will officially be covering acupuncture for the treatment of chronic low back pain. CMS states this is also a representation of the government’s commitment to giving Americans the access and the option for alternative methods of care to support the overall health of its beneficiaries.
A decision was originally projected for October 13, 2019, but the most recent information was posted on the CMS website from October 11,2019 stating they had not yet reached a decision, but there would be one forthcoming. If it is to happen, they state it will be for the year 2020 so we should have a verdict soon.
What is the opioid epidemic?
The main cause for such a proposal from Medicare, is of course the crisis currently happening in our country and according to CMS representing the government’s commitment to giving Americans access to as many options as possible to improve their health.
This crisis spans across all age groups, but becomes a big concern with those 65+ in regards to prescription opioids. Here’s some staggering stats for you:
- the amount of deaths from specifically prescription opioids rose from 8,048 in 1999 to 47,600 in 2017.
- Pain being the main reason for opioid misuse; 62.6%.
- 11.4 million misused opioids in 2017.
- 2.1 million had opioid use disorder in 2017.
CMS has stated in recent months they are currently holding clinical trials for the effects of acupuncture on chronic lower back pain and a decision will be forthcoming for the new year.
Chronic lower back pain is one of the key factors in providers prescribing opioids, but the worst part is that there is no evidence that opioids are effective at treating this very real issue long term only masking the pain at best.
This is causing the need for CMS to turn their efforts toward a better healthcare for its beneficiaries to non-pharmacologic options and defeating the dependency and misuse on opioids both in providers and patients. On top of this, there are a wide array of side effects that go along with opioid use that you just don’t see in acupuncture practices.
The cost of opioids alone, especially being misused, is enough for CMS to use acupuncture as a viable and medically necessary treatment option for coverage.
Insurances Carriers Adding Acupuncture and Dropping Opioid Coverage
Along with Medicare, other insurance carriers such as Cigna and United Healthcare have caught on to the opioid epidemic and are also dropping coverage of OxyContin and searching for alternative forms of care. Whether these companies will also be adding alternative benefits like acupuncture in the coming year remains to be seen.
In addition, other insurance companies in addition to Medicare and those mentioned are picking up (or in talks of picking up) coverage for acupuncture and other forms of alternative medicine. Until recently, insurance companies have made it extremely difficult for patients to turn anywhere but painkillers for issues of chronic pain. Here are two insurance companies that have decided to cover acupuncture:
- As of January 1, 2019, Blue Cross Blue Shield of Tennessee dropped its coverage of OxyContin and picked up coverage of acupuncture.
- As of October 3, 2019, Blue Cross Blue Shield of Massachusetts is also adding acupuncture benefits starting January 1, 2020 for 12 visits per calendar year stating “we want our members to have access to a broad range of safe, effective treatments for pain management,” said Andrew Dreyfus, president and CEO of BCBS of Massachusetts.
More insurances picking up this coverage will again be increasing options for patients and providers outside the traditional western medicine methods of using opioids for pain. Medicare coverage of acupuncture has been a long time coming and they will hopefully follow suit to these other commercial plans.
Impact on the Acupuncture Community
Medicare making the move to cover acupuncture in the coming year, even if only for lower back pain, would:
- Expand the US scientific understanding and implementation of alternative methods of care.
- Make a large difference for patients and providers with being able to see and assist more patients
- Open the eyes of the public and medical community to the benefits of Eastern Medicine, therefore potentially lowering the need of opioid medication use in the United States.
The arrival of this proposal from Medicare is also giving way to newer and larger scale studies being done on the effects of acupuncture for pain. Both the National Institutes of Health and Agency for Healthcare Research and Quality are collaborating on research.