Parity final rule tells insurers to stop using NQTLs

Abstract

The final rule amending NQTL (non-quantitative treatment limitation) standards for parity of substance use disorder (SUD) and mental health was issued by the federal government last week. The NQTL standards are key — more than 15 years after the parity law (MHPAEA) was enacted, finally, the backdoor method that insurance companies have been using to deny care has been closed. This backdoor involves non-quantitative — meaning not day or dollar — treatment limitations, such as fail-first (also known as step therapy in which patients are required to fail at one kind of less expensive treatment before payment is authorized for another recommended but more expensive kind).