Anthem Ends Prior Authorization for Opioid Treatment

Anthem, the nation’s second-largest health insurance company, agreed in January to halt its use of prior authorization for medications used to treat individuals for opioid use disorder.

The agreement with the New York state attorney general’s office ends such requirements when medications are prescribed by specially trained clinicians who are authorized by the Substance Abuse and Mental Health Services Administration. Those medications include buprenorphine and buprenorphine/naloxone.

The settlement is part of an ongoing effort to enforce parity by New York Attorney General Eric Schneiderman, who announced a similar agreement with Cigna in October 2016 (Psychiatric News, December 2, 2016).

The agreement applies to Anthem nationally, and its New York affiliate, Empire Blue Cross Blue Shield, must also end use of prior authorization for injectable naltrexone.

Imposition of prior-authorization requirements on medication treatment for opioid addiction has been an issue with several health plans doing business in New York, said Seth P. Stein, J.D., executive director of the New York State Psychiatric Association, in an email to Psychiatric News.

“The New York State Psychiatric Association [NYSPA] brought some of these improper requirements to the attention of the attorney general,” said Stein. “NYSPA is very pleased that the attorney general’s office has taken decisive action on this issue to ensure that individuals with substance use disorders are not subjected to discriminatory coverage provisions and are able to receive necessary medications without undue restriction and delay.”

“There is a need for more adequate networks of providers who are certified to treat opiate addiction,” said APA President Maria A. Oquendo, M.D., Ph.D. “Hopefully, elimination of administrative barriers like prior authorization will encourage more clinicians to become certified in treating opioid addiction and more patients to access care.”

In July 2016, the Department of Health and Human Services announced a rule change expanding from 100 to 275 the number of patients a specially trained physician can treat with buprenorphine, following a 100-patient limit for at least a year (Psychiatric News, August 5, 2016).

The disparities created by the need for prior authorization were inconsistent with state and federal mental health parity laws, said Schneiderman in a statement. “We’re committed to continue working with health insurers across the country to eliminate barriers to lifesaving opioid addiction treatments.”

Anthem’s prior authorization requirements for medication-assisted treatment were ended as of January 19, said Lori McLaughlin, communications director for the company, in response to a query from Psychiatric News.

“Anthem Inc.’s decision to remove prior authorization for oral medication-assisted therapy was based on a lengthy internal review that took place over the course of the past year,” said McLaughlin. “We appreciate the attorney general’s attention to this critical issue.”

The settlement ends a significant barrier to treatment access for opioid addition, said Colleen Coyle, J.D., APA’s general counsel. “Continuous application for prior authorization for treatment, which is often denied, wastes the time and resources of the clinician and delays or eliminates life-saving treatment.” ■