Anthem is the second large insurer to end a requirement that prevents providers from prescribing treatments for opioid addiction without prior authorization.
Cigna Corp. announced a similar policy change in October 2016 as part of an effort to improve access to opioid treatment and curb the growing number of overdoses.
Like Cigna, Anthem made the policy change after New York Attorney General Eric Schneiderman launched an investigation to uncover barriers to treatment as a result of the policy.
Prior authorization mandates that providers answer numerous questions about a patient's treatment and medication history before they receive approval to prescribe medicated-assisted treatment, or MAT. The process often causes treatment to be delayed by several days.
“Removing prior authorization improves access,” said Andrew Kolodny, director of the Opioid Policy Research Collaborative at Brandeis University.
But Anthem has taken its plan to increase access to addiction treatment one step further, vowing to help its “affiliated health plans double the number of consumers who receive behavioral health services” as part of MAT.
MAT usually involves the use of buprenorphine and naloxone along with counseling. The treatment has gained support for its effectiveness to treat opioid addiction.
The Indianapolis-based insurer has aimed that its affiliated health plans will “receive tens of thousands of more counseling visits by 2019,” said Lori McLaughlin, a spokeswoman for Anthem.
Anthem found that only about 16-19% of its members that take MAT medications also receive the recommended level of in-person counseling.
Anthem said that it will work with physicians to coordinate care with behavioral health professionals to ensure patients receive counseling services if necessary. In addition, Anthem has rolled out standardized MAT therapy coding to ensure consistent reimbursement.
“Population-wide addiction is not something that is resolved within a year or two,” said Dr. Craig Samitt, Anthem chief clinical officer. “We will continue our efforts and collaborate with others to create an environment that provides access to appropriate treatment and reduces addiction.”
The push toward value-based reimbursement offers an incentive to insurers like Anthem to work with providers to address barriers and continuum of care services, said Dr. Krisda Chaiyachati, a primary care provider and researcher at the University of Pennsylvania.
But to achieve more access for patients is easier said than done.
Physicians face both social and time-consuming barriers to treat patients with opioid addiction, Kolodny said.
A physician must go through an eight-hour certification process and apply for a license to prescribe buprenorphine. There is also a limit to the number of patients a physician can prescribe for the treatment. A physician can prescribe buprenorphine to no more than 275 patients.
Kolodny said these factors often prevent physicians from getting certified and has resulted in a shortage of services.
About 36,480 physicians, of the 900,000 in the U.S., are certified to prescribe buprenorphine, according to the Substance Abuse and Mental Health Services Administration.
There is also a shortage of mental health professionals, especially in rural areas, which could make it difficult to increase access to behavioral health therapies, Chaiyachati said.
A persistent stigma toward people who suffer from addiction also prevents some physicians from offering treatment, Kolodny said “There is this notion that people with addiction are somehow bad or difficult,” he said.
Chaiyachati said that stigma is a core barrier to addressing the opioid epidemic but it's still important to address the other barriers that exist, including prior authorization, to increase access.
“If you're trying to tackle stigma plus what's needed to prescribe (MAT treatments) than you have a compounding challenge that prevents providers from doing it to begin with,” Chaiyachati said.
