LSMS Request - End Prior Authorization for Opioid Treatment in Louisiana
Wednesday, October 24, 2018
Posted by: Christopher LeBouef
October 18, 2018
October 18, 2018
The Honorable John Bel Edwards
Governor of Louisiana
Office of Governor John Bel Edwards
900 N 3rd St #4
Baton Rouge, LA 70802
The Louisiana State Medical Society (LSMS) strongly urges the State of Louisiana to follow in the footsteps of Pennsylvania in removing prior authorization requirements for treatment of substance use disorders. We believe and support all initiatives which will result in streamlining the efforts of saving lives in Louisiana. Louisiana can and should serve as a leader in this effort.
We ask that you take immediate action to remove the barriers of such by eliminating prior authorization requirements relative to opioid treatment in Louisiana.
Governor Wolf of Pennsylvania and his administration announced Friday, October 12, 2018, a landmark agreement with the seven major payers in the Commonwealth to end prior authorization for medication-assisted treatment as well ensure that medication-assisted treatment (MAT) is on the lowest cost-sharing tier. Highlights from the announcement can be found below:
“It is vital we take all possible steps to make sure patients are receiving the most appropriate treatment for their pain, while at the same time appropriately managing and monitoring the risks associated with opioids,” Department of Health Secretary Dr. Rachel Levine said. “Medication-assisted treatment is an effective, evidence-based treatment to help those with the disease of addiction to opioids and this step by private insurers allows more people with opioid use disorder to be able to access this form of treatment. Treatment works, and recovery is possible for those who are battling this disease.”
These guidelines apply to individual, small group, and large group fully insured plans. Self-funded plans, where employers provide health care coverage administered by a third party, are regulated by the federal government and are not included in this agreement.
The guidelines implement thresholds for prior authorization for long- and short-acting opioids, morphine milligram equivalents (MME) and exceptions for active cancer, sickle cell crisis, and palliative care/hospice patients. Generally, commercial insurers are requiring prior authorization for all long-acting opioid prescriptions and short-acting opioid prescriptions after seven days. Some insurers are phasing in their alignment with many of the guidelines. Patients should consult with their insurer to find out how these guidelines are being incorporated into their specific health plan.
Providing unrestricted access to all commonly used forms of MAT when patients need it is critical to ensuring any individual struggling with addiction can access the type of treatment that is best for them. Under this agreement, commercial insurers will cover MAT without prior authorization in the following ways:
• Coverage of at least one Buprenorphine/naloxone combination product
• Coverage of Methadone as MAT
• Coverage of injectable and oral Naltrexone
Commercial insurers have also committed to coverage of at least one form of nasal naloxone without quantity limits.
The guidelines also provide that MAT will be covered at the lowest patient cost tier on the plan’s pharmacy benefit, as applicable.
Once again, the LSMS implores your leadership in the State of Louisiana to take immediate action to follow in the footsteps of Pennsylvania in removing prior authorization requirements for treatment of substance use disorders.
Susan M. Bankston, MD
President, Louisiana State Medical Society
Office of the Governor:
John Bel Edwards, Governor of Louisiana
Nick Albares, Policy Advisor at Office of Louisiana Governor John Bel Edwards
Richard Carbo, Deputy Chief of Staff for Louisiana Governor John Bel Edwards
Micah Cormier, Press Secretary at the Office of the Louisiana Governor John Bel Edwards
Louisiana Department of Health:
Rebekah Gee, MD – Secretary, Louisiana Department of Health
Pete Croughan, Chief of Staff, Louisiana Department of Health
Louisiana Senate Health & Welfare Committee:
Senator Fred H. Mills, Jr., Chairman
Senator Regina Barrow, Vice-Chairman
Senator Gerald Boudreaux
Senator "Norby" Chabert
Senator Dan Claitor
Senator Yvonne Colomb
Senator Dale M. Erdey
Senator Jay Luneau
Senator Edward j Price
Louisiana House Health & Welfare Committee:
Frank A. Hoffmann, Chairman
Bob Hensgens, Vice-Chairman
Charles R. Chaney
Kenny R. Cox
Marcus L. Hunter
Katrina R. Jackson
Robert A. Johnson
H. Bernard LeBas
J. Rogers Pope
Joseph A. Stagni
Taylor F. Barras
Walt Leger III
American Medical Association:
Jack Deutsch, American Medical Association Media & Editorial