OBJECTIVES: To determine the extent of coverage for opioids and other pharmacological and nonpharmacological treatments for low back pain, we examined coverage policies for 63 pharmacologic and 12 non-pharmacologic treatments for low back pain in Medi-Cal, California’s Medicaid program, Anthem, a large private insurer and CVS Caremark, a large pharmacy benefit manager. METHODS: We assessed the extent of and barriers to coverage using Medi-Cal’s Contract Drug List, Anthem’s 4-Tier National Formulary and CVS Caremark’s Value Formulary for medication coverage, and provider manuals and medical policies for coverage of non-pharmacologic treatments. RESULTS: Of 63 prescription drug products for back pain, Medi-Cal covered 23 (37%) products, Anthem covered 52 (83%), and CVS Caremark covered 30 (48%). Medi-Cal and Anthem covered roughly the same number of opioids as non-opioids, while CVS Caremark covered twice as many non-opioids as opioids. Eighteen (29%) products were covered by all three payers and 8 (13%) were not covered by any, totaling 26 (41%) products unanimously covered or not covered across all three programs. Prior authorization was more frequently required for Medi-Cal non-opioids (31%) and CVS opioids (50%) than for other payers and product groups. Quantity limits were very often imposed for opioids. Among non-pharmacological therapies, Medi-Cal covered occupational therapy, acupuncture and chiropractic care up to 2 visits per month. Anthem covered a modestly greater variety of non-pharmacological treatments with fewer limits on the number of visits covered. Neither Medi-Cal nor Anthem covered treatments such as biofeedback, transcranial magnetic stimulation, cognitive behavioral therapy, or yoga. CONCLUSIONS: Coverage is an important driver of utilization of specific healthcare services. Our analysis found substantial variability in the coverage of non-opioid pharmacologic and non-pharmacologic treatments for low back pain among these payers. Coverage restrictions may diminish the use of alternatives to opioids in settings where such alternatives have a favorable risk-benefit balance.