What’s the news: New Jersey Gov. Phil Murphy and District of Columbia Mayor Muriel Bowser removed prior authorization (PA) requirements for Medicaid enrollees who need medication-assisted treatment (MAT) for opioid-use disorder.
Why it matters to patients and physicians: The actions taken in New Jersey and Washington will save lives. About 130 people die each day in the U.S. from an opioid-related overdose and a recent U.S. Government Accountability Office report found that 92% of people with a substance-use disorder (17.2 million people) went untreated.
Now commercial payers must follow Medicaid’s example, said AMA President-elect Patrice A. Harris, MD.
“While more Medicaid agencies are taking similar action, we continue to see other states and commercial markets still supporting prior authorization—a practice that serves only to delay and deny treatment,” said Dr. Harris, MD, who chairs the AMA Opioid Task Force. “As we know from our patients, delayed treatment can have deadly consequences.”
The AMA urges removing all barriers to MAT and points to Pennsylvania as a model of how to do it. Not only did Gov. Tom Wolf remove PA for MAT for Medicaid enrollees, he persuaded seven major commercial insurers in the commonwealth to also drop prior authorization requirements for medication-assisted treatment and include MAT medications on the lowest cost-sharing tier.
“MAT helps people maintain recovery, saves money, reduces crime, and helps people regain their health and their lives,” wrote AMA President Barbara L. McAneny, MD, in an AMA Leadership Viewpoints column hailing the Pennsylvania agreement.
What’s next? For physicians interested in removing prior authorization for medication-assisted treatment in their states, the AMA provides model legislation that can be used as a foundation for a law in their state.
In addition to removing prior authorization for MAT in Medicaid and the commercial markets, the AMA model bill requires MAT to be on the lowest cost-sharing tier, extends MAT protections to correctional settings and includes provisions to strengthen oversight and enforcement of mental health and substance-use disorder parity laws.
