Pennsylvania insurers eliminate prior authorization for substance abuse treatment

Pennsylvania Gov. Tom Wolf
Seven insurers reached an agreement with Pennsylvania Gov. Tom Wolf to pare back prior authorization for substance abuse treatment. (Governor Tom Wolf/CC BY 2.0)

Seven insurers have agreed to remove prior authorization requirements for substance abuse treatment in Pennsylvania, marking a win for provider groups that have long argued that the restrictions have “deadly consequences" for patients. 

The insurers reached an agreement with the Commonwealth of Pennsylvania to remove the coverage restrictions and include a broader range of medications to treat substance use disorders on the lowest cost-sharing tier. That includes the most common drugs buprenorphine and methadone, as well as at least one form of nasal naloxone.

Pennsylvania implemented similar efforts earlier this year in the Medicaid program.


Fuel Top Line Growth and Increase Membership

In this webinar, payers can learn how to accelerate the sales pipeline and grow membership across all health insurance market segments using comprehensive sales technologies.

“Medication-assisted treatment is an effective, evidence-based treatment to help those with the disease of addiction to opioids and this step by private insurers allows more people with opioid use disorder to be able to access this form of treatment,” Department of Health Secretary Rachel Levine, M.D., said in a statement. “Treatment works, and recovery is possible for those who are battling this disease.”

The insurers include Aetna, Capital BlueCross, Geisinger, Highmark, Independence Blue Cross, UPMC, and UnitedHealthcare. The agreement includes individual, small group and large group plans, but not self-funded health plans, which are regulated by the federal government.

American Medical Association President-elect Patrice A. Harris, M.D., urged other states to follow suit.

“We have long advocated for the removal of prior authorization and other barriers to increase access to medication-assisted treatment (MAT) for substance use disorders,” she said in a statement. “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.”

Pennsylvania Medical Society President Theodore A. Christopher, M.D., said the change would “bring much-needed certainty and clarity to physician practices” around substance abuse treatment.

Insurers have relaxed their policies around substance abuse treatment over the last several years, particularly around the use of Suboxone. Two years ago, Cigna agreed to halt prior authorization for patients receiving MAT for opioid addiction following an agreement with former New York Attorney General Eric Schneiderman.