States need to continue efforts to remove prior authorization for treatment of opioid use disorder as well as better enforce network adequacy standards for addiction and mental illness, according to two new studies from the Legal Action Center and Center on Addiction.
The Spotlight on Legislation Limiting the Use of Prior Authorization for Substance Use Disorder Services and Medications examines state statutory standards that limit the use of prior authorization in both public and private insurance. According to the study, "as of April 20, 2020, 21 states and the District of Columbia have enacted laws that limit public and/or private insurers from imposing prior authorization requirements on a SUD service or medication. Since 2019 alone, 15 jurisdictions enacted such laws." The AMA, in partnership with state and specialty societies, has supported many of those laws through AMA model legislation and direct advocacy. In the Spotlight on Network Adequacy Standards for Substance Use Disorder and Mental Health Services, the organizations describe the federal and state regulatory framework for defining and monitoring network adequacy for public and private health plans and offers recommendations to improve and enforce network adequacy standards. Many of these recommendations align with those in the AMA-Manatt Health national policy roadmap (PDF), released last fall. Among its recommendations, the AMA called for policymakers to ensure adequate networks that allow for timely access to addiction medicine physicians and other health care professionals; this includes payment reforms, collaborative care models, and other efforts to bolster and support the nation's opioid use disorder treatment workforce.View other recent research on the nation's opioid epidemic.