For many decades, mental health clinicians have looked over the health care parity fence at the medical and surgical providers’ lot and envied their patients’ better health insurance coverage with its greater access, increased number and frequency of visits, lower deductibles, fewer exclusions, and better out-of-network coverage. In practice, as a patient’s expenditures rise, mental health insurance coverage becomes less and less generous, while, conversely, medical/surgical coverage becomes more and more generous, primarily due to stop-loss provisions.

More recently, a series of federal and state laws and regulations have sought to enforce greater equality between medical/surgical insurance coverage and mental health (MH) and substance use disorder (SUD) insurance-covered services. While it is still too early to pass definitive judgment on the longer-term effects of these efforts, a number of trends are becoming apparent.

The wish to improve MH/SUD services relative to the rest of U.S. health care can be traced to the Kennedy Administration,1 but it has required a series of federal and state laws and regulations starting with the 1996 Mental Health Parity Act (MHPA) and most notably the 2010 Mental Health Parity and Addiction Equality Act (MHPAEA) to make major inroads into the flagrant inequities between medical/surgical and MH/SUD health insurance coverage.

Health insurance parity is typically assessed both quantitatively and qualitatively. Examples of quantitative indices include copays, frequency of treatment, number of visits, days of coverage, deductibles, and out-of-network coverage. Qualitative measures include the need for prior authorization, frequency of medical necessity and utilization reviews, drug formularies, fail-first barriers, and exclusions based on prior treatment,........

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