Following Cigna, Anthem changes preauthorization policy for medication-assisted therapy treatment

Anthem is ending its policy of requiring prior authorization for medication-assisted treatment for opioid use disorder.

Anthem affiliated health plans recently removed their policy for prior authorization of drugs, such as buprenorphine, to treat opioid addiction, according to the insurer.

The preauthorization was intended to help ensure clinically appropriate use, including that the member was enrolled in comprehensive counseling services, Anthem said.

Anthem announced its change in policy at the same time the New York Attorney General's Office said it had reached a national agreement with Anthem over the insurer's prior authorization practices for medication-assisted therapy treatment for opioid use disorder.

This policy change will apply not only to most Anthem members in New York, but nationally as well, Attorney General Eric Schneiderman said.

The agreement comes several months after Schneiderman announced a similar agreement with Cigna.

[Also: Cigna to cut customer use of opioids by 25 percent over 3 years]

Medication assisted therapy, when prescribed and monitored properly, has proven effective in helping patients recover from opioid use disorder, and is both safe and cost-effective in reducing the risk of overdose, the AG's office said.

"I am pleased that this is the second national settlement my office has reached with major insurers to remove hurdles to opioid addiction treatment," Schneiderman said.

Anthem required providers to submit a prior approval form for medication-assisted therapy, or MAT coverage requests. They required the provider, who had already received specific training regarding MAT and federal authorization to prescribe these drugs, to answer numerous questions about the patient's current treatment and medication history.

[Also: Prior authorization needs streamlining, new healthcare coalition including AMA, MGMA says]

The Attorney General's investigation revealed that Empire Blue Cross Blue Shield in New York denied nearly 8 percent of the overall requests for coverage of MAT in 2015 and the first half of 2016. This subsequently caused significant delays in patients obtaining treatment for addiction – or patients never obtaining the treatment at all, Schneiderman said.

In contrast, Empire BCBS did not require prior authorization for the majority of drugs it covers for medical conditions, including opioids fentanyl, morphine, tramadol, and oxycodone, when prescribed for pain, the AG's Office said.

[Also: Opioid-related hospital stays spike 64%, cost billions in ER, hospital care each year]

The investigation determined that these disparities were not consistent with the New York and federal mental health parity laws, which require health plans to cover mental health and substance use disorder treatment the same way they cover treatment for physical conditions.

Anthem said it has been identifying ways to help consumers get better access to treatment.

Last year three Anthem affiliated health plans in the northeast began rolling out standardized medication-assisted therapy coding for both psychiatrists and non-psychiatrist physicians certified to support MAT treatment to maximize their reimbursement and make it consistent for subsequent visits.

In addition, Anthem said it is working to connect non-psychiatrist MDs to behavioral health support to help members get counseling while receiving their drug therapy. Anthem wants health plans to double the number of consumers seeking behavioral health counseling for opioid addiction, it said.

These efforts will be extended to all Anthem affiliated health plan states by early 2018, the insurer said.

The goal, said Anthem, is for affiliated health plans to reduce the amount of opioids dispensed among their members by 30 percent from historic peak levels, by the end of 2019.

Also, all of Anthem's individual and employer, and government-sponsored health plans have been implementing quantity limits on short and long-acting opioids to help prevent addiction.

Twitter: @SusanJMorse