Aetna Becomes Latest Insurer to End Prior Authorization for Opioid Treatment

Following similar actions by Cigna and Anthem, Aetna has announced it will do away with requirements that force doctors to get approval from the insurer before prescribing medications to treat opioid addiction.

Medication-assisted therapies (MATs) like suboxone and buprenorphine can be prescribed by physicians to treat the symptoms of withdrawal when a patient stops taking opioids. However, the prior authorization requirements compel doctors to fill out forms and wait hours or even days for approval before they can prescribe the medications. This causes delays during a crucial window for patients seeking help. As such, these rules have become an easy target for policy makers seeking solutions to help quell the current opioid epidemic.

New York Attorney General Eric Schneiderman has been one of the most prominent advocates fighting against the prior authorization policies. After conducting investigations, he facilitated separate settlements with Cigna last October and Anthem in January that ended the practice of pre-authorization for MAT prescribed to their privately insured members in New York. The insurers then chose to implement the changes nationwide. Anthem announced after the agreement that it would also endeavor to reduce the amount of opioids prescribed to members and improve access to behavioral health services.

Schneiderman's efforts were applauded by the American Medical Association, which in early February issued a letter to attorneys general across the country encouraging them to take similar actions. The organization stated that utilization management strategies, including prior authorization and step therapy protocols, often have an adverse, even life-threatening, effect on patients seeking help.

“The very manual, time-consuming processes used in these policies interrupts care for patients and causes providers (physician practices, pharmacies and hospitals) to divert valuable resources away from direct patient care,” according to the letter. “There is no medical, policy or other reason for payers to use prior authorization for MAT, and we hope that New York’s efforts will be the first of many similar ones across the nation.”

In an interview with The American Journal of Managed Care^®, Prosecutor Joseph D. Coronato of Ocean County, NJ, discussed the importance of prompt treatment for addicts who are experiencing withdrawal in a medical setting.

“If you’re going to make a difference in that person’s life, you have to get them while the teardrops are warm,” he said. Many patients who leave without treatment will often return to their old patterns of drug abuse, representing “a lost opportunity” for the healthcare provider.