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AMA calls for end to insurer prior authorization policy

Anthem, Cigna have already ended policy of prior authorization for medication assisted treatment for substance use disorders.

Susan Morse, Senior Editor

The American Medical Association is urging attorneys general in all states to take the same action as recently taken by the New York AG in ending the insurance company policy of requiring prior authorization for medication-assisted treatment of substance use disorders.

In addition, the AMA is calling on all insurers to end policies that require patients to repeat step therapy protocols or retry therapies failed under other benefit plans before qualifying for medication-assisted treatment coverage.

The AMA made its requests in a Feb. 3 letter to the National Association of Attorneys General and the Office of the State Attorney in Connecticut.

It follows last month's announcement by the New York Attorney General Eric Schneiderman that Anthem would do as Cigna had previously done in ending its policy of prior authorization for medication-assisted treatment. The policy change applies not only to New York, but nationally, Schneiderman said.

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

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

AMA said prior authorization is a time-consuming process that delays care.

"With respect to opioid use disorders, that could mean relapse or death from overdose," said James L. Madara, MD, AMA executive vice president and CEO. "Whether methadone maintenance treatment, buprenorphine, naltrexone, or other MAT therapies, the evidence is unequivocal that treatment works."

Last month, the AMA joined a coalition of 16 other healthcare organizations urging health plans, benefit managers and others to end prior authorization requirements imposed on medical tests, procedures, devices and drugs.

"The AMA believes that attorneys general can reach the same agreement with all payers, and we pledge our public support in making that happen," Madara said.

Twitter: @SusanJMorse

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