Expenses for mental illness and substance abuse treatment increased only slightly after implementation of Oregon's law requiring parity between insurance coverage for these disorders and coverage for other conditions. The changes in the four commercial plans examined by McConnell et al. (p. 31) were similar to those in self-insurance plans exempt from parity. The periods compared were the 2 years before and 2 years after the law took effect in 2007. Management of behavioral health benefits through nonquantitative treatment limitations, such as documentation of medical necessity, prior authorization, and utilization review, was allowed but had to conform with restrictions on medical-surgical coverage. This similarity to the federal parity law implemented in 2009 suggests to editorialist Susan Busch (p. 1) that the new federal requirement of insurance parity will not “break the bank.”
Clinical Guidance: Effects of Paroxetine Treatment During PTSD Exposure Therapy
Patients with posttraumatic stress disorder (PTSD) from experiences during the World Trade Center attack responded better to paroxetine, up to 50 mg/day, than placebo over 10 weeks of exposure therapy that included weekly 90-minute guided imagery sessions and cognitive-behavioral exercises. Schneier et al. (p. 80) report that by week 10, 42% of patients in the paroxetine group remitted, compared to 17% in the placebo group. The differences did not persist for patients who continued therapies beyond 10 weeks; by week 22, the remission rate was 45% for both treatments among those remaining in the study.