This month Aetna joined fellow insurers Anthem and Cigna in dropping the prior authorization requirement for privately insured patients to prescribe “particular medications ― such as Suboxone ― that are used to mitigate withdrawal symptoms.” Aetna is the third leading health care insurer to drop the pre-authorization in recent months.

Opioid abuse in the United States is a serious public health issue and drug overdose deaths involving opioids and heroin continue to sweep across the country at epidemic proportions. Suboxone is one of several drugs used to treat narcotic (opiate) addiction. To medical professionals, addiction specialists, and families of loved ones addicted to opioids and heroin, the pre-authorization that insurers currently have in place is a barrier to timely and effective treatment.

“This is great news,” says Dr. Henry Paul, Executive Director of the Karen Horney Clinic in NYC. “When a patient decides right then and there that they want treatment to kick their addiction, you need to begin treatment at that moment. The window of opportunity to treat patients who want to kick their addiction is minuscule and you can’t send them away expecting they’ll come back tomorrow. By then they will be back using because the craving for the drugs is just too powerful.”

In February NPR reported on Aetna’s change saying, “Specifically, the company will stop requiring doctors to seek approval from the insurance company before they prescribe particular medications ― such as Suboxone ― that are used to ease withdrawal symptoms.”

So how long were the pre-authorization delays? Sometimes hours and sometimes days. Pre-authorization may seem like a simple technicality but any delay, however brief, puts a person’s ability to get well at risk.

Both Cigna and Anthem changed their policy after facing an investigation by New York’s Attorney General in to whether their coverage practices unfairly barred patients from needed treatment. Aetna’s change takes effect this month and it is expected that more states will begin their own investigations and other insurers will follow suit and drop their pre-authorization requirement.

Another Big Health Insurer Loosens Rules For Covering Addiction Treatment  (NPR News, 2/15/2017)

Facing Pressure, Insurance Plans Loosen Rules For Covering Addiction Treatment  (KHN, 2/21/2017)

Information contained in this blog is intended for educational purposes only. It is not intended as medical or psychiatric advice for individual conditions or treatment and does not substitute for a medical or psychiatric examination. A psychiatrist must make a determination about any treatment or prescription.