Behavioral health providers in one state have come out on top in a battle to remove prior authorization requirements for opioid use disorder (OUD) treatment.
The Michigan Department of Health and Human Services (MDHHS) announced this week it would do away with prior authorization requirements for medication-assisted treatment (MAT) drugs in Medicaid plans, effective immediately.
The move is another win for behavioral health providers pushing for public and private payers nationwide to remove prior authorization requirements for MAT, which has been shown to reduce opioid use, deaths, crime and infections infectious diseases, according to the National Institute on Drug Abuse.
For Michigan Medicaid beneficiaries, the news means drugs such as buprenorphine, which diminishes opioid withdrawal symptoms, will be easier for recovering OUD patients to acces.
“The removal of prior authorization for these medications in the Medicaid program will helpincrease access to treatment for people with opioid use disorders,” Joneigh Khaldun, chief medical executive and chief deputy for health for MDHHS, said in a press release announcing the change. “By eliminating this requirement, medical providers will be empowered to help people begin treatment when they are ready and increase their chances of a successful recovery.”
Prior authorization stipulations they generally require physicians to get approval from a patient’s health insurer before moving forward with treatment. While the goal is often to prevent fraud and abuse, behavioral health providers often argue that such requirements present a significant barrier to care to MAT services, which are heralded as the most effective recovery option for OUD patients.
Brooke Feldman, manager of the Philadelphia CleanSlate Outpatient Addiction Medicine center, argued just that last month at the Payer’s Behavioral Health Management and Policy Summit in Washington, D.C.
CleanSlate Outpatient Addiction Medicine is a national outpatient addiction treatment center with dozens of locations across 11 states.
Feldman told conference attendees OUD patients frequently reach out to CleanSlate centers across the country seeking MAT services — only to be told they must wait hours or days for medication due to prior authorization requirements.
“Prior authorizations really are a nightmare,” Feldman told conference attendees. “They often are just to protect costs, but I promise you the person … who walks away from treatment services because of a prior authorization delay, he’s still using drugs [and] costing you a lot more money.”
In addition to Michigan, 21 other states have removed prior authorization requirements for Medicaid beneficiaries seeking MAT treatment, increasing access to services for recovering patients without increasing their risk of drug diversion.
However, the removal of prior authorization requirements has been less widespread in the commercial sector.
In October 2018, Pennsylvania Gov. Tom Wolf announced an agreement with seven major insurers in the state to remove prior-authorization requirements for MAT services there.
Following the news, the American Medical Association (AMA) urged other states to do the same.
“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,” AMA President and opioid task force chair Patrice Harris said in a statement.
However, few states have attempted to follow suit.