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AMA praises Aetna's decision to ease access to opioid treatment
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The AMA has commended Aetna for eliminating prior authorization for opioid treatment. The company is the latest health insurer to take this step, and reflects a larger trend of insurers implementing policies to help combat the nation’s increasing opioid addiction crisis.
“Patient lives will be saved by Aetna’s decision to remove prior authorization for treatment of substance use disorders,” Patrice Harris, MD, MA, chair of the AMA Board of Trustees and chair of the AMA Task Force to Reduce Opioid Abuse, said in a release. “The AMA has advocated strongly for removing this hurdle, and we are pleased by Aetna’s announcement. 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.”
The new policy takes effect March 1.
According to the AMA release, the New York Attorney General announced in October that Cigna and Anthem ended their policies of prior authorization for medication-assisted treatment in the United States.
“It’s incumbent on us to evaluate our programs and policies on a continuous basis and determine whether they are positively impacting our members,” Sherry Dubester, vice president of behavioral health and clinical programs at Anthem, said in a press release. “We are committed to making changes and discovering other ways to better solve for these health care issues.”
Acknowledging the scope of opioid addiction, which the CDC has called an epidemic, Anthem and Cigna have taken additional steps.
Anthem announced plans to lower the amount of opioids dispensed among its members by 30% of peak levels by the end of 2019.
“Untreated opioid use disorders put consumers at increased risk for experiencing a number of medical issues, including overdose, infectious diseases associated with intravenous drug use, and death,” Craig Samitt, MD, chief clinical officer at Anthem, said in a release. “Making improvements with coordination and integration of medical and behavioral health care is an important factor to consider in efforts to mitigate these medical risks. Health insurers can and should play a strong role in making changes to improve the lives of their members.”
Cigna recently asked medical practices to reduce opioid use and improve pain management and substance use treatment where appropriate.
“Improving the quality of care and delivering better health outcomes for our customers are at the core of Cigna Collaborative Care. Adopting this pledge is an opportunity to shine a light on one of the biggest crises we face in health care today and enables us to work collaboratively with our clinical partners to find effective solutions,” Dick Salmon, MD, vice president and national medical executive for performance measurement and improvement for Cigna, said in a release. “It’s not enough to just sign the pledge. We’re counting on these groups to commit to taking specific actions and we will discuss results as part of our ongoing quality reviews.”
AMA has created a task force to reduce opioid abuse and has also joined a group of health care organizations seeking changes on the prior authorization requirements imposed on medical tests, procedures, devices and drugs.
The AMA release noted that in 2015, 2 million Americans had a substance use disorder involving opioid analgesics. In addition, almost 600,000 people have a substance use disorder involving heroin and more than 33,000 Americans died in 2015 due to an opioid-related overdose.
Further reading:
www.ama-assn.org/ama-commends-aetna-commitment-opioids-treatment
http://ir.antheminc.com/phoenix.zhtml?c=130104&p=irol-newsArticle&ID=2238162
www.cigna.com/newsroom/news-releases/2016/cigna-encourages-medical-practices-to-sign-opioid-pledge
Disclosure: Harris is a member of AMA. Dubester and Samitt work for Anthem, and Salmon works for Cigna.
Perspective
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Abimbola Farinde, PhD
With the growing awareness of the crisis of the opioid epidemic in our society, impactful measures are being implemented to curtail the growth of this phenomenon that has been linked to numerous overdoses, associated infections, and at unintentional deaths. According to the CDC, in 2015 the number of deaths associated with illicit opioid use increased substantially in comparison to the previous year. Hospitals, clinics, and pharmacies have also experienced the effects of the rise in opioid abuse across this nation, and there isa growing desire from all three areas to assist with addiction prevention and increasing access to opioid addiction care. Historically, many communities have been devastated by the number of unintentional overdoses related to the current opioid epidemic and this has gradually set stage for a significant change to occur. In an effort to address the alarming rate at which opioids are being abused across America, a handful of health insurers have started to remove the requirement for prior authorization for opioid addiction treatment. While evaluating for the clinical appropriateness of this treatment is important, this process can sometimes hinder or prevent treatment for those that truly require the intervention. The intended goal of this measure is to increase the likelihood of access to medication assisted therapy for opioid addiction, and this has the potential to witness many opioid abusers entering treatment for the first time. For those that experience a delay in access to this evidence-based care this can mean continued use of opioids, which left untreated can lead to untimely deaths. The removal of the prior authorization requirement for opioid addiction treatment can hopefully be seen as the first step in a series of steps that are designed to control the rise of the opioid issue in America.
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