AMA calls on states to remove prior authorization for opioid treatment

Agreement with Pennsylvania insurers serves as model for the nation

Following the news that Pennsylvania will remove prior authorization requirements for medication-assisted treatment (MAT) for opioid-use disorder, the president of the American Medical Association (AMA) called on payers in every state to do the same.

“Payers across the nation commonly impose prior-authorization requirements that patients and physicians must meet before medications are available for treatment,” said Barbara McAneny, AMA president, in a statement. “When patients seek help, it is unconscionable to make them wait days or weeks for the right treatment.”

According to the U.S. Surgeon General, MAT is considered the “gold standard” for treating opioid-use disorder.

Last fall, Pennsylvania Governor Tom Wolf and his administration announced an agreement with seven major health insurance companies in the state to remove prior-authorization requirements for MAT. The agreement includes giving patients and providers a choice of a range of medications to treat substance-use disorders on the lowest cost-sharing tier of a health plan’s pharmacy benefit. Insurers must also cover at least one form of naloxone, without quantity limit restrictions in place.

McAneny is urging physicians to join AMA in advocating for payers in all states to remove this barrier to MAT by asking state and specialty medical societies to partner with AMA.

“If the payers won’t do it on their own, then we urge state medical societies to partner with us to help introduce our model legislation—“Ensuring Access to Medication Assisted Treatment”—and work to get it enacted,” she said.

The focus of the AMA bill is to prohibit utilization-management barriers such as step therapy and prior authorization for MAT. The bill will require payers to provide coverage and access to all forms of MAT as well.