Medicaid removes prior authorization requirements for opioid addiction treatment medication

Comment; Prior Authorizations are ridiculous. Insurers need to “credential” providers before allowing them “in network”, then throw more obstacles that we’re not paid for to separate our patients, their clients from the care we “credentialed” providers think they need. It should be illegal!

By: Anthony Vecchione
April 2, 2019 2:38 pm

New Jersey Human Services Commissioner Carole Johnson announced on April 1, that NJ Medicaid plans will no longer require prior authorization before patients can access medication-assisted treatment for opioid addiction — removing a barrier to care and allowing Medicaid recipients to get quicker access to proven treatment.

The action is part of Gov. Phil Murphy’s initiative to combat the opioid epidemic. In 2018, more than 3,000 individuals in New Jersey died due to overdose.

According to the NJHSC the move means those needing opioid addiction treatment will no longer have to wait for approval for medication-assisted treatment (MAT). MAT is the clinical standard and evidence-based strategy for treating opioid addiction and advancing recovery.

Our goal is to remove barriers to opioid addiction treatment everywhere they exist and increase the pool of health care providers offering this critical treatment so that we can help individuals and families for whom this care is a matter of life or death.

New Jersey’s Medicaid program serves about 1.7 million residents and is managed by the New Jersey Department of Human Services.

“Medicaid recipients can now receive proven treatment for opioid addiction as soon as their health care provider prescribes it,” Johnson said in a statement.

“When someone with an opioid addiction is ready for treatment, we shouldn’t be losing them to care while they wait for approval. Our Medicaid plans have worked with us to get this change implemented quickly, and we hope it will make a meaningful difference in terms of timely access to care. We also hope it will encourage more health care providers to offer medication-assisted treatment because it will reduce the time and paperwork associated with delivering this care.”

Human Services Deputy Commissioner Sarah Adelman said that New Jersey’s Medicaid program is a valuable tool in the fight against the opioid epidemic.

“With this change, we are easing burdens and removing barriers to care to help increase treatment and prevent overdose. Our goal is to save lives,” said Adelman.

Dr. John Poole, president of the Medical Society of New Jersey, applauded the change.

“The Medical Society of New Jersey fully supports the announcement and the increased access to treatment for our patients.”

Dr. Patrice Harris, president-elect of the American Medical Association, chair of the AMA Opioid Task Force commended Murphy and Johnson for “helping end needless administrative barriers to evidence-based treatment for patients with an opioid use disorder. ”

Harris said that lives will be saved by no longer requiring prior authorization for medication-assisted treatment.

“The AMA strongly urges all states that have not taken this step to do so immediately. Removing prior authorization for MAT should be occurring in every state Medicaid agency—and in the commercial and self-insured markets,” said Harris.

“While more Medicaid agencies are taking similar action, we continue to see other states and commercial markets still supporting prior authorization — a practice that serves only to delay and deny treatment. As we know from our patients, delayed treatment can have deadly consequences.”

Harris added that the announcement includes plans to invest in increased physician capacity, establish centers of excellence, and ensure that MAT is offered to all patients.

“These are hallmarks of the type of leadership necessary to end the opioid epidemic,” said Harris.

“This is a great step forward toward a more enlightened understanding of the importance to engage persons who are seeking treatment from their addictions, at the time when they are initially motivated, said Joe Masciandaro, president and chief executive officer, Care Plus New Jersey, based in Paramus.

“The futility of requiring prior authorizations for life-saving medications, which are then approved 100 percent of the time (after a 24-72 hour delay) is self-evident and imposed an onerous effort on doctors, nurses, and other treatment providers, which thankfully will no longer be necessary. A reason to celebrate,” said Masciandaro.

Removing the prior authorization requirements for MAT is among several steps being taken by the Murphy administration to combat the opioid epidemic in New Jersey. Other steps NJ Human Services is taking to increase access to care include: Investing in training more primary care physicians, nurse practitioners and physician assistants to provide MAT for opioid addiction; creating new Medicaid payment incentives to encourage primary care providers to offer MAT; funding two Medicaid Centers of Excellence for opioid treatment – one at Rutgers New Jersey Medical School in Newark and one at Cooper Medical School of Rowan University – to provide community providers access to addiction experts and supports; and requiring residential treatment facilities that receive Medicaid payment to provide access to MAT as of July 1.

“Our goal is to remove barriers to opioid addiction treatment everywhere they exist and increase the pool of health care providers offering this critical treatment so that we can help individuals and families for whom this care is a matter of life or death,” Johnson said.