A Brighter Horizon for Opioid Recovery
Three years after being declared a National Health Emergency, the U.S. battle against the opioid addiction epidemic is gaining some traction. A crisis that, for many people, began with the overprescribing of opiates for pain management, should be readily addressed by the medical community.
Unfortunately, processes designed to keep medical costs down or protect patients from unnecessary or unsafe treatments, depending on which side of the aisle you reside have served to discourage, and in some cases, block the efforts of patients and doctors to dull the knife of opioid use.
Prior authorization, wherein certain tests or treatments have to be authorized by insurance before they can be prescribed and covered by insurance, slows down the process of a patient gaining access to Medication Assisted Treatment (MAT). It can take multiple days for an authorization to go through (consider a request sent on a Friday or going into a holiday), at which point, a recovering addict can relapse, or someone in the throes of addiction can lose resolve or, worse, overdose.
Medications that could help with long-term relapse, curb withdrawal symptoms, or reverse an overdose need to be easily accessible, with little to no layover between the time the need presents itself and the time medication can be administered.
With a call to eliminate prior authorization requirements for MAT prescriptions, some states’ insurance companies are changing their approach.
In 2018, Pennsylvania’s seven largest insurance providers (Aetna, Capital Blue Cross, Geisinger, Highmark, Independence Blue Cross, UPMC, and United Healthcare) did away with prior authorization for MAT prescriptions.
In April 2019, Arkansas Act 964 passed, requiring all health insurers and the Arkansas Medicaid program to remove prior authorization to FDA-approved medications that have been shown to support recovery, including buprenorphine, methadone, and naltrexone.
Just this month, Wisconsin insurance companies and healthcare providers announced an agreement to do away with prior authorization requirements for most patients when the prescription is needed to help fight drug abuse. Insurance companies on board include Anthem Blue Cross and Blue Shield, Children’s Community Health Plan, Dean Health Plan, Network Health, MercyCare Health Plans, Quartz, Security Health Plan, United Healthcare and WPS Health Solutions.
Early April 2019, New Jersey’s Department of Human Services announced that the state’s Medicaid plans, which serve 1.7 million people, will no longer require prior authorization before patients can access medication-assisted treatment for opioid use disorder.
Washington and Rhode Island have eliminated the need for prior authorization for MAT prescriptions for Medicaid patients.
California, by and large (minus buprenorphine under Medicaid coverage), still requires prior authorization for MAT prescriptions, although work is underway to turn that around.
Meanwhile, and always, remember that there is no one-size-fits-all approach to addiction recovery. While MAT definitely has its benefits and may be helpful for you, therapeutic interventions and lifestyle changes should accompany it; in some cases, those are enough to get you and keep you clean and sober. For life.
The California MAT Expansion Project aims to increase access to MAT, reduce unmet treatment needs, and reduce opioid overdose-related deaths through the provision of prevention, treatment, and recovery activities. The California MAT Expansion Project focuses on populations with limited MAT access, including rural areas and American Indian & Alaska Native tribal communities. The California MAT Expansion Project is funded by grants from the Substance Abuse and Mental Health Services Administration (SAMHSA).