Anthem ending opioid treatment preauthorization nationwide

Anthem has reached a settlement with New York Attorney General Eric Schneiderman to end its policy requiring prior authorization for medication-assisted treatment (MAT) for opioid addiction.

Under the previous policy, Schneiderman said Anthem’s New York subsidiary, Empire Blue Cross Blue Shield, denied about 8 percent of requests to cover the treatment in 2015 and the first half of 2016. In contrast, the opioid painkillers which may have led to a patient’s disorder, like fentanyl, morphine and oxycodone didn’t require preauthorization.

To Schneiderman, this put Anthem in violation of parity laws requiring substance abuse treatment to be covered the same as other conditions.

““We’re facing an opioid crisis in New York and around the country – and we should be doing whatever we can to make lifesaving treatments accessible to those suffering from addiction,” Schneiderman said in a statement. “I am pleased that this is the second national settlement my office has reached with major insurers to remove hurdles to opioid addiction treatment. While we’ve made progress, there are too many still suffering. We’re committed to continue working with health insurers across the country to eliminate barriers to lifesaving opioid addiction treatments.”

His office had reached a similar settlement with Cigna in October.

While the case was settled in New York, Anthem is instituting the policy nationwide.

“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,” said Anthem Chief Clinical Officer Craig Samitt, MD. “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.”

Under the agreement in New York, Empire BCBS will provide education on the treatments to providers and helping them obtain certification from the Substance Abuse and Mental Health Services Administration to prescribe buprenorphine and buprenorphine/naloxone as part of MAT for opioid dependence.