Oct. 18, 2018: Advocacy spotlight on Pennsylvania removes prior authorization for opioid treatment


Pennsylvania Gov. Tom Wolf announced a landmark agreement last week with seven major insurers to end prior authorization for medication-assisted treatment (MAT) for substance-use disorders (SUDs). Insurers also committed to including a comprehensive range of medications to treat SUDs on the lowest cost-sharing tier of a health plan's pharmacy benefit. The AMA is extremely pleased with this result.

"We have long advocated for the removal of prior authorization and other barriers to increase access to medication-assisted treatment for substance-use disorders," said AMA President-elect Patrice A. Harris, MD. "The leadership shown by the governor and his administration to reach this agreement should act as a call for all states to demonstrate that they support patients' access to care over needless administrative burdens."

The AMA and medical society efforts have included direct advocacy with key policymakers within the state, national-level advocacy with payers and national policymaking groups, and federal advocacy in support of removing barriers to high-quality, evidence-based care. Now that payers in Pennsylvania have recognized the importance of removing prior authorization and other barriers to MAT, the AMA will encourage payers in every state to show similar leadership.

"We commend the governor for his leadership in bringing together all major stakeholders in reaching this agreement," said Pennsylvania Medical Society President Theodore A. Christopher, MD, FACEP. "Today's agreement will bring much-needed certainty and clarity to physician practices when we are helping our patients access treatment for a substance-use disorder."

Prior authorization—sometimes called precertification or prior approval—is a process by which patients, physicians or other health care providers must obtain advance approval from a health plan to qualify for payment before a specific service or treatment is delivered to the patient. Applying prior authorization to patients with SUDs can have deadly consequences if patients are forced to delay care or have that care denied.

MAT is the evidence-based standard for treating people with opioid-use disorder to help sustain recovery and save lives. In the past year, nearly 15,000 physicians have become certified to provide MAT—a 42 percent increase nationwide.

To learn about the Pennsylvania Medical Society efforts to help reverse the epidemic, visit www.pamedsoc.org/OpioidResources.

To learn about the AMA's work to end the nation's opioid epidemic, visit www.end-opioid-epidemic.org.