Pennsylvania Removes Prior Authorization for Opioid Treatment

CHICAGO, Illinois, Oct. 12 -- The American Medical Association issued the following news release:

The Commonwealth of Pennsylvania and seven major health insurance companies agreed today to remove prior authorization requirements for treatment of substance use disorders, a move that has the potential to save thousands of lives, according to the American Medical Association (AMA) and Pennsylvania Medical Society.

In addition to removing this unnecessary restriction on treatment, insurers have also committed to including a comprehensive range of medications to treat substance use disorders on the lowest cost-sharing tier of a health plan's pharmacy benefit as part of this agreement.

"We have long advocated for the removal of prior authorization and other barriers to increase access to medication-assisted treatment (MAT) for substance use disorders," said AMA President-elect Patrice A. Harris, MD, MA. "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."

"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 health plan 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 is delivered to the patient. Applying prior authorization to patients with substance use disorders 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.