Advocacy Update

Feb. 22, 2019: State Advocacy Update


In his proposed Fiscal Year 2020 New York State Executive Budget, New York Governor Andrew Cuomo included provisions that would help put an end to health insurer policies of prior authorization for medication-assisted treatment (MAT) for opioid use disorder.

Haven't subscribed?

Stay current on the latest on the issues impacting physicians, patients and the health care environment with the AMA’s Advocacy Update newsletter.

"As an addiction and psychiatric medicine physician, I can tell you firsthand that prior authorization for medication-assisted treatment is harmful to patients because it delays care," said Frank Dowling, MD, the Medical Society of the State of New York physician representative to the AMA Opioid Task Force. "Immediate availability of medication when a patient is willing to accept treatment is critical to improve chances of success. If a patient with an opioid use disorder is told to wait a few days by the health insurance company, that could be the difference between life and death. It's got to stop."

In a letter (PDF), Dr. Madara urged the New York Legislature to support the governor's MAT provisions.

For more information, please contact Moe Auster from the Medical Society of the State of New York.

California attorney general Xavier Bacerra recently called for health insurance companies to immediately stop delaying or denying care to patients who need treatment for a substance use disorder. These practices include requiring patients to obtain prior authorization for medication-assisted treatment (MAT). The AMA and California Medical Association (CMA) applaud Becerra for his support of patients with a substance use disorder. According to the U.S. Surgeon General, MAT is the gold standard for treatment for those with a substance use disorder.

"There is no reason for health insurance companies to require patients to jump through hoops when they are seeking care for a substance use disorder," said AMA President-elect Patrice A. Harris, MD, MA, who chairs the AMA Opioid Task Force. "Tens of thousands of patients are dying in our nation each year in this epidemic, and it will not end unless our patients have increased access, without delay, to high-quality, evidence-based medical care."

The attorney general's action mirrors legislation sponsored by CMA in 2018. AB 2384 by Assemblymember Joaquin Arambula, MD, would have required health plans who offer prescription drug benefits to cover medication-assisted treatment for opioid addiction and other forms of substance abuse. That measure was vetoed by Gov. Jerry Brown amid strong opposition from health plans. Becerra's action is the latest in a series of state efforts physicians hope becomes a national movement to remove barriers to patients with a substance use disorder and end the nation's opioid epidemic. As the attorney general notes, "Burdensome prior authorization processes affect 40% of patients with private health insurance who attempt to access MAT. Such prior authorization policies keep MAT from benefiting the widest possible range of individuals and families in serious need.

"The Attorney General's actions will ensure that those seeking treatment for opioid use disorders are able to receive it without arduous delays and waiting for health plan approval," said David H. Aizuss, MD, president of the California Medical Association.

Only a few other states have taken this type of action. The New York Attorney General's office reached agreements with Aetna, Cigna and Anthem in 2017 for those payers to stop requiring prior authorization for MAT. In Maryland, which removed prior authorization for MAT in 2017, physicians report that the law is saving lives. Pennsylvania reached an agreement with the Commonwealth's seven largest payers in 2018 to remove prior authorization for MAT. And several state legislatures are considering bills this year to prohibit prior authorization for MAT.

"It is clear to us that health insurance companies increasingly realize there's no valid reason to require prior authorization for MAT," said Dr. Harris. "We strongly urge all of California's health insurance companies to immediately comply with and agree to Attorney General Becerra's request to help end the opioid epidemic in California."