OBJECTIVES: Autism spectrum disorder (ASD) is a neurodevelopmental condition characterized by deficits in social and communication skills. Early intensive behavioral intervention services, which can cost tens of thousands of dollars per year, are increasingly being reimbursed by health plans for children with ASD diagnoses. This study assessed the contribution of behavioral intervention-related services to increases in spending among children aged 3–7 years enrolled in employer-sponsored health plans for children who had ASD-coded approved claims.

METHODS: We analyzed MarketScan® Commercial Database claims data from 2016 to 2021 to identify children with ≥2 claims with ASD diagnosis codes within a calendar year, i.e., “current-year ASD.” We estimated mean and median annual expenditures per child with and without current-year ASD in 2021 US dollars, both overall and by service type. Mean spending by US Census division and rural vs non-rural residence were also estimated.

RESULTS: Mean spending per child aged 3‒7 years with current-year ASD increased by 66% for children, rising from $18,559 in 2016 to $30,788 in 2021. For children with none or one ASD claim, spending decreased by 0.3%. Mean spending on behavioral intervention-related services per child with ASD increased by 183%, from $7,081 in 2016 to $20,042 in 2021, while spending on non-behavioral related services decreased by 6%. Mean spending per child with ASD increased by 88% in rural areas and 65% in non-rural areas.

CONCLUSIONS: Rapid increases in spending for young children with ASD enrolled in large-employer–sponsored plans from 2016 to 2021 were driven by changes in behavioral intervention–related spending. Spending on non-behavioral services for children with ASD and overall spending for other children in the same plans was stable during the study period. The relative increase in spending per child with ASD was somewhat greater in rural areas, leading to a modest relative reduction in geographic disparity.