Aetna Removes Prior Authorization for Suboxone and Other Opioid Addiction Meds

By Paul Gaita 02/22/17

Addiction specialists will no longer have to wait for approval to treat Aetna patients with opioid addiction issues. 

doctor and a patient

Aetna, one of the largest health insurance companies in the United States, has announced that it will no longer require doctors to seek prior authorization before prescribing medications used to treat opioid addiction.

The change, which will apply to all of its private insurance plans in March 2017, will address a significant roadblock for both medical professionals and patients alike, who have traditionally been required to wait hours or even days before treatment can be approved. Aetna's decision comes on the heels of similar measures by Cigna in the fall of 2016 and more recently, Anthem, which announced the change in January 2017.

Addiction specialists state that while the change may seem minor by most standards, eliminating the waiting period can mean the difference between wellness and the continued debilitating effects of opioid medication.

"If someone shows up in your office and says, 'I'm ready,' you can make it happen right then and there," said Dr. Josiah Rich, a professor of medicine and epidemiology at Brown University who also treats patients with opioid addiction issues. "But if you say, 'Come back tomorrow, or Thursday, or next week,' there's a good chance they're not coming back. Those windows of opportunity present themselves. But they open and close."

Supporters of prior authorization note that the requirement is designed to maintain a degree of safety when prescribing a drug with potentially harmful side effects, including the opioid abuse deterrent drug Suboxone.

A spokesperson for Humana—which was recently blocked by a federal judge from merging with Aetna—stated that prior authorization is used to "ensure appropriate use." The practice is also implemented by many insurance providers to limit the costs of such medications to patients, who can pay up to $500 for a month's worth of prescription drugs. 

But as the opioid addiction epidemic continues to claim more lives with each passing month—statistics show that more than 20,000 individuals died from overdoses related to prescription pain relievers in 2015—more health professionals and addiction treatment advocates have lobbied for greater oversight in regard to prior authorization.

An investigation into denials for requested coverage by both Anthem and Cigna, led by New York Attorney General Eric Schneiderman, forced the companies to reverse their stances on prior authorization as part of larger settlements; these actions spurred the American Medical Association to urge the National Association of Attorneys General to devote similar focus to insurance plans that require approval for Suboxone or other drugs.

So far, Minnesota AG Lori Swanson has initiated a similar investigation in her state, while AG Schneiderman's office has reported that other states have expressed interest in following their leads.

Such efforts underscore the primary argument against prior authorization, which prevents equal levels of treatment to all patients. According to Dr. Corey Waller, chairman of the American Society of Addiction Medicine, medical treatment for addiction is a "first-line, Food and Drug Administration-approved therapy for a disease with a known mortality. [For] every other disease with a known mortality, the first-line drugs are available right away." 

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Paul Gaita lives in Los Angeles. He has contributed to the Los Angeles Times, Variety, LA Weekly, and The Los Angeles Beat, among many other publications and websites.