Insurance Plans and Opioids: Releasing and Raising the Barriers to Prescribe

Christine Bulgozdi
Associate Editor
Loyola University Chicago School of Law, JD 2018

 

With the opioid addiction epidemic continuing to rise in the United States, several insurance companies loosened the existing barriers to addiction treatment. Aetna Insurance Company joined Cigna and Anthem in removing key provisions in its insurance plans that require additional authorization prior to providing addiction treatment. At the same time, Cigna proposed to strengthen barriers to physician prescribing of opioids in an attempt to further address the opioid epidemic.

Last fall, Cigna became the first major insurance company to loosen its restrictions related to covering addiction treatment and medication, followed by Anthem a few months later. This came in response to the New York attorney general investigations focused on unfair coverage practices. The attorney general alleged that both companies engaged in unfair coverage practices by barring patients in need of addiction treatment. Each company settled and the lifted restriction came as a term of the larger settlements.

Specifically, all three insurance companies will no longer require prior approval for a doctor to prescribe certain medications that may help with addiction. These so-called “prior authorizations” caused a significant delay, sometimes days or weeks, from the time the doctor prescribed the medication, to the time a patient could fill the prescription. According to addiction specialists, this time lapse often causes a patient to rethink their decision to obtain treatment.

In addition to providing patients with more access to addiction treatment, Cigna recently approved an additional step for prescribing long-acting opioids. Beginning in July, Cigna will require prior authorizations for opioid prescriptions that are not meant to treat cancer or other serious diseases. This extra step in the prescribing process will increase the barriers to patient access in the hopes of curtailing unnecessary opioid prescriptions.

Last year, the Centers for Disease Control and Prevention released a guidance that recommended non-opioid prescriptions as the preferred treatment for chronic pain and illnesses other than cancer. In response to these guidelines, Cigna aimed to reduce its number of patients who use opioids by at least 25 percent by 2019. This proposal continues Cigna’s efforts to reduce unnecessary opioid prescriptions as Cigna already decreased its opioid prescriptions by over 12 percent in the past 12 months.

The efforts to eliminate and strengthen barriers for opioid prescriptions address the rising opioid epidemic. Each initiative curtails opioid usage from different entry points. The addition of prior authorizations before certain opioid prescriptions are filled allows insurance companies to ensure that such strong medication is required. On the other hand, eliminating the prior authorizations before addiction treatment allows patients to get immediate assistance before changing their mind. Both insurance companies and physicians alike recognize how their prescribing habits affect their patients. Opioid abuse continues to occur, even with significant precautions taken. Additional precautions like the ones described above will hopefully further reduce the impact of opioids on the patient population.

 

 

[1] Aetna joins to relax rules covering addiction treatment.

[2] Cigna implements restrictions to opioid prescriptions.

 

 

 

 

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