Seven of the largest health insurers serving Pennsylvanians have agreed to end pre-authorization requirements for patients needing medication-assisted treatmen for opioid addictions.
As explained in a news release issued by the governor’s office,
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.
To learn more about the new approach by health insurers, including how the agreement was reached and to which medication-assisted treatments this new policy will apply, see this news release from the governor’s office.