“Patient lives will be saved by Aetna’s decision to remove prior authorization for treatment of substance use disorders,” said Dr. Patrice Harris, chair of the AMA Board of Trustees and chair of the AMA Task Force to Reduce Opioid Abuse. “The AMA has advocated strongly for removing this hurdle, and we are pleased by Aetna’s announcement. Increasing access to treatment is crucial to reversing the nation’s opioid epidemic, and we urge all payers to show the leadership that Aetna has taken to make patient care a priority over administrative hurdles.”
Physicians say that requiring prior authorization for patients delays treatment for patients who might need it immediately and might not return for treatment that is delayed several days.
The New York Attorney General recently announced an agreement with insurers Anthem and Cigna to end their policies of prior authorization for Medication Assisted Treatment (MAT) in New York and the rest of the nation.
In a follow-up letter to the National Association of Attorneys General (NAAG), the AMA urged other state attorneys general to help end insurance company policies that delay or deny care for substance use disorders. The AMA strongly supported the New York agreement and pledged its support to NAAG with reaching similar agreements with other payers across the nation. The AMA noted that more than 33,000 Americans died in 2015 due to an opioid-related overdose, 2 million had a substance use disorder involving opioid analgesics, and nearly 600,000 people have a substance use disorder involving heroin.
The AMA announced last month that it had joined a coalition of 16 other health care organizations urging health plans, benefit managers and others to reform prior authorization requirements imposed on medical tests, procedures, devices and drugs.
In 2015, the AMA launched a Task Force to Reduce Opioid Abuse and continues to work with state medical societies to address legislation and regulation ranging from developing effective prescription drug monitoring programs, continuing medical education, restrictions on treatment for opioid use disorder as well as enactment of naloxone access and Good Samaritan overdose protections.