Pennsylvania’s largest insurers have agreed to stop requiring pre-authorization for people seeking certain medications used to treat opioid addiction, the Wolf administration recently announced.
The change means people with opioid use disorder who need medications such as naloxone (Narcan), naltrexone and methadone will not have to delay treatment because they need to wait for authorization from an insurance company.
“When someone decides they are ready for treatment, time is critical,” Teresa Miller, secretary of the state Department of Human Services, said at a press conference Friday with Wolf administration officials where the agreement between the state and seven large insurers was announced.
“Time spent waiting for a service authorization makes it more difficult for the individual who initiates treatment to remain engaged in treatment,” Miller said.
Aetna, Capital BlueCross, Geisinger, Highmark, Independence Blue Cross, UPMC and United agreed to the new guidelines, which apply to individual, small group and large group fully insured plans.
“We applaud the Wolf administration on their efforts to reduce overall opioid prescriptions, as we agree that this is key to turning the opioid epidemic tide,” said Leilyn Perri, a spokesman for Pittsburgh-based Highmark, which was among the insurers that attended the press conference.
Highmark is “committed to fighting the opioids crisis with a three-pronged public health approach: primary prevention to treat pain effectively without opioids; secondary prevention to promote safe prescribing and tertiary prevention to ensure access to treatment,” Perri said.
Highmark reduced the number of opioid prescriptions for commercial members by 15 percent in 2017, he said.
Self-funded plans, where employers provide health coverage administered by a third-party, are regulated by the federal government and are not included in the agreement.
“I want to thank Gov. Wolf for his continued leadership on battling the opioid crisis in our state, and our insurers for coming to the table to find ways to cover appropriate treatment when it is needed, and for working with our medical providers,” Insurance Commissioners Jessica Altman said.
The insurers also made changes to prior-authorization requirements for all long-acting opioid prescriptions and short-acting opioid prescriptions after seven days, providing for greater medical review.
The new guidelines are similar to changes made to the Medicaid fee-for-service and managed care programs the state DHS implemented last spring after working with insurers
Dr. Rachel Levine, secretary of the Department of Health and Jen Smith, secretary of the state Department of Drug and Alcohol Programs, stressed that when people are fighting opioid addiction a few days can sometimes mean a difference between life and death.
“These changes are a key component to ensuring individuals receive the necessary care to start their journey into recovery,” Smith said.
“Now physicians can immediately begin a treatment regimen, alleviating a time-sensitive obstacle for the individual in need.”
