MADISON, Wis. (AP) — Wisconsin insurance companies, healthcare providers and others announced an agreement Tuesday to do away with prior authorization requirements for most patients that can slow the prescription of drugs to treat people fighting substance abuse.
Those involved with the deal, announced at the state Capitol, heralded it as a major advancement in the fight against addiction. The agreement will expand access to medication-assisted treatment — a method used to help those addicted to opioids — to more than a million patients, said state Rep. John Nygren.
“This is a monumental change,” Nygren said.
Most insurance companies require that before a doctor can prescribe a medication to treat substance abuse, they get prior authorization from the patient’s insurance. Under the deal, prior authorization will not be needed in most cases, Nygren said. Health insurers agreed to cover at least one product to treat opioid addiction, such as naloxone or Narcan, without pre-approval from the insurance company.
“This agreement will impact lives,” Nygren said. “It will save lives.”
There is no formal written agreement or law change, Nygren said, just a commitment from the insurance companies and others to make the change. Representatives from those taking part in the agreement said they would immediately make the change if they hadn’t already.
Those taking part in the agreement are Anthem Blue Cross and Blue Shield; Children’s Community Health Plan; Dean Health Plan; Network Health; MercyCare Health Plans; Quartz; Security Health Plan; United Healthcare; and WPS Health Solutions.
Doctors, insurance plan directors, leaders of hospitals and others all heralded the deal.
“We know this agreement today is going to save lives in Wisconsin,” said Kevin Roy, chief public policy officer for Shatterproof, a national nonprofit group that works to combat opioid addictions.
Eric Borgerding, president of the Wisconsin Hospital Association, said in a statement that prior authorization agreements often placed barriers on people seeking treatment, creating unnecessary administrative burdens to health care providers trying to treat people with substance abuse addictions.
Any delay in treatment can lead to patients relapsing back into addiction, so removing this barrier will help them remain sober, said Dr. David Galbis-Reig, president of the Wisconsin Society of Addiction Medicine.
Nygren, a Republican from Marinette, has worked for years to combat the state’s opioid crisis. Nygren’s own daughter has struggled with addiction and he’s told her story as he’s guided the passage of more than two dozen law changes, known as the HOPE agenda, since 2014.
The state Assembly on Tuesday was also slated to pass a package of bills that are part of the HOPE agenda designed to address addiction and make it easier to treat pain without prescribing opioids.
One bill would prohibit penalizing state employees for using medication-assisted treatments for opioid addiction. Under another proposal, county jails would have easier access and training to use Narcan, which is given to rapidly reverse an opioid addiction. Another measure would create a Medicaid benefit for peer recovery coach services.