Insurer rules a hurdle for patients overcoming opioid dependency

Prior authorization rules--"the dark shadows of the insurance industry"--are hampering much-needed treatment options for those hoping to recover from opioid abuse, experts tell NPR.

Patients report waiting up to five days before receiving their prescriptions for Suboxone, a medication that helps people in the grip of opioid withdrawals, according to the article. Sam Muszynski of the American Psychiatric Association says getting prior authorization can take weeks.

In general, the prior authorization process adds a bureaucratic layer that zaps doctors’ productivity, consuming up to 868.4 million hours annually. Some insurers have implemented electronic prior authorization systems to increase efficiency, but believe the use of prior authorization will not lessen with the rise of value-based care.

The delay also opens the door for relapse while patients wait for medication.

“It’s almost like when you take on a patient to treat opiate addiction, you also have to take on another patient called the insurance company,” Andrew Chambers, M.D., said in an interview with NPR.

The issue highlights the inequity of doctors freely prescribing medication for physical illnesses, yet showing reluctance to disburse treatments for mental health and substance abuse illnesses, according to the article. Insurers also sometimes use prior authorization requirements to pressure physicians into lowering doses of Suboxone or shortening length of treatment time, NPR says.

Conversely, insurers have been stepping up their efforts to combat the opioid abuse crisis. This week, Aetna sent notices to 931 painkiller "superprescribers" with data on their prescription habits, an endeavor that could reduce the number of prescribed pills by 1.4 million. Meanwhile, insurers like CeltiCare Health Plan have hired social workers to assist in patient recovery. And Blue Cross Blue Shield Massachusetts has implemented a policy of limiting the number of opioids in a patient's initial prescription.

- read the NPR article