Large insurers drop barriers to prescribing medications for opioid use disorder

February 21, 2017
Area(s) of Interest: Drug Prescribing/Dispensing Patient Care 

Three of the nation's largest insurers—Aetna, Cigna, and Anthem Blue Cross—have in recent months announced that they will no longer require physicians to seek prior approval before prescribing medication to treat opioid use disorder.

These policy changes come as more than 2.2 million people meet the diagnostic criteria for an opioid use disorder. Treatment of opioid use disorder with opioid maintenance therapies has been shown to be cost-effective, safe and successful when used appropriately.

Increasing access to treatment is crucial to addressing opioid misuse and overdose, and the California Medical Association urges all insurers to make patient care a priority over administrative hurdles.  Prior authorization often has a negative impact on patient care when there is a delay or interruption in ongoing treatment due to a health plan utilization authorization.

According to the American Medical Association, 75 percent of surveyed physicians described prior authorization burdens as high or extremely high. More than a third of physicians reported having staff that work exclusively on prior authorization.

Nearly 60 percent of physicians reported that their practices wait, on average, at least one business day for prior authorization decisions, and more than 25 percent of physicians said they wait three business days or longer.

Contact: Samantha Pellon, (916) 551-2887 or spellon@cmadocs.org.


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