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AMA Calls to Eliminate Prior Authorization for MAT Patient Access

In an impassioned essay, AMA President Barbara L. McAneny advocated for removing prior authorization from MAT therapies to improve patient access.

prior authorization patient access

Source: Thinkstock

By Sara Heath

- Eliminating prior authorization regulations will be essential for expanding patient access to medication assisted treatment (MAT) for opioid use disorder (OUD), asserted American Medical Association President Barbara L. McAneny, MD.

“When it comes to treating patients with OUD, we know what works,” McAneny said in a recently-published essay on the topic. “MAT for opioid-use disorder saves lives. MAT helps people maintain recovery, saves money, reduces crime, and helps people regain their health and their lives.”

However, complex prior authorization regulations often get in they way of patients trying to access these treatments. Healthcare payers utilize prior authorizations to control spending by asking patients to await approval before gaining access to a treatment or a drug.

In theory, prior authorization should ensure that patients who truly need a drug have access to it, but encourage those who can recover using less costly interventions to utilize those options.

In reality, however, prior authorization delays access to crucial treatments, McAneny said.

“But time is of the essence, and payers across the nation commonly impose prior-authorization requirements that patients and physicians must meet before medications are available for treatment,” she wrote. “When patients seek help, it is unconscionable to make them wait days or weeks for the right treatment. There is no valid reason to delay or deny medically proven care that can help end the nation’s opioid epidemic and improve patients’ health and lives.”

Eliminating prior authorization protocol would help patients connect with necessary treatment faster and more efficiently, ultimately making a dent in the opioid crisis, McAneny argued. In Pennsylvania, for example, where seven of the state’s leading insurers recently got rid of prior authorization rules, the state of the opioid crisis has improved.

Nearly 5,000 individuals died of opioid overdose between March of 2017 and March of 2018, according to an AMA report regarding Pennsylvania’s opioid programs. Expanding patient access to MAT is expected to improve health equity and close that opioids death toll.

“This agreement between the Commonwealth and the seven largest payers could serve as a national model for other states that we will be watching closely as the agreement is implemented,” AMA wrote in its report, on which it partnered with the Pennsylvania Medical Society (PAMED) and Manatt Health Today. “The agreement also addressed standardizing prior authorization for opioid prescriptions when opioids remain the appropriate medication as discussed in the section on pain management.”

Although AMA and PAMED do not yet have statistics showing the impact of expanded MAT access, representatives from both groups asserted Pennsylvania’s actions will be crucial to the fight against the opioid crisis. After all, MAT is effective at treating OUD. Making those treatments available in a timely and affordable manner will make it so more patients are able to receive the interventions they need.

The action to remove prior authorization regulations from MAT access must be accompanied by a culture change, AMA noted in its spotlight report on Pennsylvania. Stigma is still a considerable barrier to care access, and until that can be surmounted, patients will continue to fall through the treatment access cracks.

However, this first step should serve as a national example, said AMA president-elect Patrice A. Harris, MD.

“The leadership shown by the governor and his administration to reach this agreement should act as a call for all states to demonstrate that they support patients’ access to care over needless administrative burdens,” said Harris, who his also the AMA Opioid Task Force Chair.

McAneny echoed that sentiment, encouraging providers in other states to encourage their state policymakers and leading insurance companies to follow Pennsylvania’s lead. Further, collaboration on and support for AMA’s legislation, Ensuring Access to Medication Assisted Treatment, could help achieve the organization’s patient care access goals.

“We all certainly have more work to do, but unless and until all payers agree to remove all barriers to such care, opportunities to save lives will be missed,” McAneny concluded. “Together, we can change policy and save lives.”

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