Pennsylvania and seven major health insurance companies reached an agreement Oct. 12 to remove prior authorization requirements for opioid treatment.
Under the agreement, insurers committed to remove prior authorization for substance use disorder treatment and include various medicines to treat substance use disorders on the lowest cost-sharing tier of a health plan's pharmacy benefit, according to the American Medical Association and Pennsylvania Medical Society.
The prior authorization process requires patients, physicians or other healthcare providers to get advance insurer approval to be eligible for payment before a patient receives a specific service. By removing prior authorization for opioid treatment, thousands of lives could potentially be saved, according to the AMA and Pennsylvania Medical Society.
"We have long advocated for the removal of prior authorization and other barriers to increase access to medication-assisted treatment for substance use disorders," said AMA President-elect Patrice Harris, MD. "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."