Aetna Drops Prior Authorization Requirement for Opioid Addiction Treatment

Aetna, one of the largest insurers in the nation, announced that it will drop requirements for doctors to obtain prior authorization from the insurer before prescribing medications to treat opioid addiction, according to Kaiser Health News. The change will apply to all of Aetna’s private insurance plans beginning in March.

According to the CDC, opioid overdoses have quadrupled since 1999, and opioids were involved in more than 33,000 deaths in 2015. Medications such as Suboxone (buprenorphine and naloxone; Indivior) are often prescribed by physicians to treat symptoms of withdrawal, but prior authorization requirements may results in delays of hours to days before a patient can get the treatment they require. Doctors say that, during the delay, patients may change their minds about wanting treatment or may relapse if they start to experience withdrawal.

With its decision, Aetna joins Anthem Inc and Cigna, both of which have dropped their prior authorization requirements for anti-addiction treatment in the past year. Currently, some other large insurers such as UnitedHealthcare and Humana continue to list a prior authorization requirement for some, if not all, versions of anti-addiction medicine on their drug formularies.

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Prior authorization requirements are often imposed for potentially dangerous medications in order to ensure patients receive appropriate care. Such requirements are also used by insurers to limit the prescribing of expensive medications. It is estimated that drugs that treat opioid addiction can cost as much as $500 for one month of treatment.

In response to the announcement, the American Medical Association released a statement praising Aetna for the decision. “The AMA has advocated strongly for removing this hurdle, and we are pleased by Aetna's announcement,” said Patrice Harris, MD, chair of the AMA board of trustees and chair of the AMA Task Force to Reduce Opioid Abuse. “Increasing access to treatment is crucial to reversing the nation's opioid epidemic, and we urge all payers to show the leadership that Aetna has taken to make patient care a priority over administrative hurdles.”

—Julie Gould (Mazurkiewicz)