Insurer: No more prior auths for opioid addiction meds

Cigna is ending its prior authorization policy for medication-assisted treatment (MAT) for opioid use disorder.

This move comes months after New York State Attorney General Eric T. Schneiderman requested that the insurer supply information about its MAT policies to address concerns about barriers to treatment for opioid use disorder. 

“The misuse of opioids has taken a terrible toll in America, which is why Cigna is committed to reducing opioid use among our customers by 25% in three years,” says Karen Eldred, Cigna public relations. “As part of comprehensive efforts to combat the opioid epidemic, under our commercial plans we have agreed to voluntarily remove prior authorization from all medications used in MAT for opioid use disorder. This will help make it easier for our customers to access coverage for the medications they need.”

As the nation’s opioid epidemic continues to intensify, consider joining trailblazers from health plans, pharmacies and healthcare companies at CBI’s inaugural Prescription Drug Monitoring Programs. This summit will focus on the crucial elements of managing how drugs are prescribed, dispensed and reimbursed.

When prescribed and monitored properly, MAT has been proven effective in helping patients recover from opioid use disorder, and is both safe and cost-effective to reduce the risk of overdose. According to the Substance Abuse and Mental Health Services Administration, although cost varies for each, the most common medications used in treatment of opioid addiction are methadone, buprenorphine, and naltrexone.

This policy change will apply not only to most members in New York, but nationally as well. 

Every year, more Americans die from drug overdoses than in traffic accidents, and more than three out of five of these deaths involve an opioid. Since 1999, the number of overdose deaths involving opioids, including prescription opioid pain relievers, heroin, and fentanyl, has nearly quadrupled, according to a White House release.

Brill

“Cigna has been on the leading edge of working with the American Society of Addiction Medicine [ASAM] on substance use disorders,” according to Managed Healthcare Executive editorial advisor Joel V. Brill, MD, chief medical officer at Predictive Health.

Back in May, Cigna announced its collaboration with the ASAM to improve treatment for people with substance abuse disorders.

Clark“Plans generally apply more stringent medical management techniques, both as written and/or as applied in operation, including prior authorization, concurrent and retrospective review requirements, to mental health or substance use disorder [MH/SUD] benefits than to medical/surgical benefits,” Kelly Clark, MD, MBA, DFASAM, ASAM president-elect, tells Managed Healthcare Executive.

One of the most common complaints of ASAM members is non-parity-compliant prior authorization requirements for addiction medications, according to Clark. “This was part of the comments that ASAM submitted to the White House Mental Health and Substance Use Disorder Parity Task Force,” she says.

The final report of the Task Force can be found here.

Next: Prior authorizations examined

Previously, Cigna required providers to submit a prior approval form for MAT requests, which required the providers, who had already received specific training regarding MAT in order to prescribe these drugs, to answer numerous questions about the patient’s current treatment and medication history. In some cases, authorization took days, according to a release from Attorney General Schneiderman.

Herrick“The likely reason Cigna required preauthorization in the first place is because the anti-opioid drug, buprenorphine, is susceptible to abuse by people who use it to get high or trade in it. The risk is apparently serious enough that the federal government also limits access to buprenorphine. The New York attorney general may have felt Cigna’s preauthorization was redundant,” says Devon Herrick, senior fellow at the National Center for Policy Analysis.

Professor of business administration at Simon Business School at the University of Rochester, Gerry Wedig, agrees that prior authorization was presumably in place to prevent abuse of buprenorphine "for which there is a black market," he says. "I would not be surprised to see other insurers adopt the Cigna policy as the opioid addiction epidemic is quite severe."

WedigCigna undoubtedly wants to discourage opioid abuse, since that can add to other health costs, Herrick says. “Industry data has found that for every $1 dollar of opioid drugs lost to fraud and abuse there is another $42 lost to doctor shopping and other health costs, such as unnecessary ER visits. At the same time, Cigna doesn't want to add to opioid abuse by freely distributing a drug that is abused by addicts.”

Other health plans will probably review Cigna’s case and look for ways to make buprenorphine available but not abused, according to Herrick. “How other insurers do this may be partly determined by whether they too become the subject of regulatory scrutiny by New York or other states,” he says.

“We hope that other health plans will follow in [Cigna’s] footsteps and that the White House report will also address these prior authorization barriers from a parity perspective,” says Clark.