Eliminating Prior-Authorization Requirements for Medications for Opioid Use Disorder
In this scenario, health insurance providers cover the cost of MAT as a standard benefit and all requirements that a physician contact the insurance provider for approval prior to writing the prescription (a process called “prior authorization”) are removed. Without these prior authorization requirements, prescriptions for MAT medications to treat opioid use disorder can be written and filled as soon as a physician deems this treatment necessary, free from artificial delays.
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Why this strategy works Prior authorizations may take up to several days to process with insurance providers. This processing time creates an immediate barrier to a patient's initiation onto treatment. This delay forces patients to leave their provider's office without receiving potentially life-saving medication, only to return again to receive it several days later. During that time, treatment can be derailed. A patient may lose interest, lose access to their doctor, lose transportation, suffer injury, or even die from an overdose.
The removal of prior authorization requirements allows a patient to be initiated onto treatment the same day they see their doctor. This immediate initiation reduces the patient's risk of overdose in subsequent days and increases the likelihood that they will successfully engage in and remain connected to treatment.
Due to regulations governing the provision of methadone, buprenorphine and naltrexone are the only FDA-approved medications for opioid use disorder potentially subject to prior authorization requirements. |
Removing prior authorization requirements works best when:
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Eliminating prior-authorization requirements for medications for opioid use disorder-What the research says
- In 2014, prior authorization for prescription buprenorphine what still required for 35% of Health Maintenance Organizations (HMOs), 36% of Preferred Provider Organizations (PPOs), and more than half of Consumer Driven Products (CDPs).
- Self-treatment with diverted (i.e. misused) opioid medications is common among individuals with opioid use disorder who have recently experienced barriers to or delays in starting buprenorphine-based MAT.