Insurer Will Stop Preauthorization for Opioid Treatment

Cigna, the large national health insurance company, voluntarily agreed on October 19 to stop requiring prior authorization for medication-assisted treatment (MAT) of opioid use disorder in an agreement with New York State Attorney General Eric Schneiderman’s office. The attorney general in turn agreed to discontinue its investigation into Cigna’s coverage of MAT.

“Other health insurers should take notice of Cigna’s actions to remove access barriers to treat opioid dependency, and I encourage those insurers to follow suit,” said Schneiderman in a statement.

Previously, Cigna had demanded that prescribers submit answers to several questions about a patient’s treatment and medication history. Receiving approval often took several days, noted the attorney general.

The agreement covers buprenorphine and buprenorphine/naloxone and other treatments and was greeted positively by addiction medicine specialists. Clinicians consider preauthorization an unnecessary, and sometimes self-defeating, barrier to treatment.

“Asking for preauthorization for buprenorphine may delay treatment for several days when you have a very small window of opportunity to intervene with our patients,” said Petros Levounis, M.D., professor and chair of the Department of Psychiatry at Rutgers New Jersey Medical School in Newark. “Maybe they are in crisis or at last have summoned the willpower to do something. You often have to strike when the iron is hot, so not having to deal with preauthorization really opens the door to effective treatment and saving lives.”

Insurers have tended to frame the restriction as a “quality measure,” but such concern should be unnecessary because doctors authorized to use buprenorphine must be specially trained anyway, said Levounis.

The American Society of Addiction Medicine (ASAM) also noted its approval of the agreement.

“Waiting for days to obtain medication to treat this condition represents an unnecessary risk for a deadly outcome,” said Kelly Clark, M.D., M.B.A., president-elect of ASAM, in a statement. “Hopefully, other payers will follow Cigna’s lead in decreasing barriers to access to this lifesaving medication.”

“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 percent in three years,” commented Cigna public relations representative Karen Eldred in an email to Psychiatric News. “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 medication-assisted treatment for opioid use disorder. This will help make it easier for our customers to access coverage for the medications they need.”

The agreement sets a precedent and could become the norm, said Levounis.

“This change in policy will apply to all Cigna commercial health plans (including self-funded plans) and government-sponsored group health plans in the state of New York and, more broadly, nationwide,” wrote assistant attorneys general Brant Campbell and Michael Reisman in a letter to Cigna. “Additionally, Cigna will maintain its policy of not requiring prior authorization for other MAT medications, including the following: methadone, naltrexone, disulfram, and acamprosate.”

In a separate measure, New York state also recently passed legislation removing prior authorization of MAT treatment for Medicaid beneficiaries. ■

The New York state attorney general’s letter to Cigna can be accessed here.