Aetna has declared that it will no longer need doctors to seek prior authorization before prescribing opioid addiction medicines used to treat opioid addiction.
The change, which will apply to all of its private insurance plans in the year of March 2017, will deal an important roadblock for both medical expert and patients alike, who’ve traditionally been needed to wait hours or even days before treatment can be passed. The decision of Aetna comes on the heels of similar measures by Cigna in the fall of 2016 year and more recently, Anthem, which declared the changes e in the month of January 2017.
Addiction specialists state that while the change might appear minor by most standards, removing the waiting period can mean the difference between wellness and the continued debilitating impacts of opioid addiction medicines.
“If someone indicates up in your office and says, ‘I am ready,’ you can make it happen right then and there,” stated Dr. Josiah Rich, a professor of medicine and epidemiology at Brown University who also treats sufferers with opioid addiction medicines problems. “But if you say, ‘Come back tomorrow, or Thursday, or next week,’ there is a great chance they are not coming back. Those windows of opportunity present themselves. But they open and close.”
Supporters of prior authorization point out that the requirement is designed to maintain a degree of safety when prescribing a drug with possibly harmful side effects, involving the opioid abuse deterrent drug Suboxone.
A spokesperson for Humana—which was blocked by a federal judge recently from merging with Aetna—claimed that prior authorization is utilized to “ensure appropriate use.” The practice is also executed by several insurance providers to limit the charges of such medications to sufferers, who can pay up to $500 for a month’s worth of prescription drugs.
But as the opioid addiction epidemic sustains to claim more lives with each passing month—statistics indicate that more than 20,000 people passed away from overdoses related to prescription pain relievers in the year of 2015—more health experts and addiction treatment advocates have lobbied for higher oversight in regard to prior authorization.
An inquiry into denials for requested coverage by both Anthem and Cigna, led by New York Attorney General Eric Schneiderman, compelled the companies to reverse their stances on prior authorization as part of larger settlements; these actions spurred the American Medical Association to urge the National Association of Attorneys General to devote similar concentrate to insurance plans that need approval for Suboxone or other drugs.
So far, Minnesota AG Lori Swanson has started a similar investigation in her state, while AG Schneiderman’s office has reported that other states have depicted interest in following their leads.
Such attempts underscore the primary argument against prior authorization, which stops equal levels of treatment to all patients. In accordance to Dr. Corey Waller, chairman of the American Society of Addiction Medicine, medical treatment for addiction is a “first-line, Food and Drug Administration-approved therapy for an ailment with a known mortality. [For] every other infection with a known mortality, the first-line drugs are available right away.”
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