PSAM Opposes Prior Authorization on Evidence-Based Addiction Treatment – InsuranceNewsNet


CHEVY CHASE, Maryland, 21 Sept (TNSGov) — The Pennsylvania Society of Addiction Medicine issued the following press release:

On 09/20the Pennsylvania Society for Addiction Medicine (PSAM) sent a letter to the members of the Home Insurance Committee violating section 2118 of SB 225. Section 2118 allows insurers to implement prior authorization for addiction treatment drugs (MAT) beyond the original prescription and establish preferred drug policies.

In the letter, PSAM highlighted the adverse impact that prior approval can have on patient outcomes. According to surveys, 93% of physicians reported treatment delays due to prior approval. In addition, 82% of physicians indicated that prior approval could lead to treatment discontinuation. PSAM emphasized that delays and uncertainties caused by prior approvals can mean the difference between life and death for people with addiction. Delays in receiving medication prescriptions can result in a return to use, overdose, or other adverse experiences that negatively impact treatment outcomes. In addition, PSAM found that prior approval and preferred medication guidelines limit physicians’ ability to provide evidence-based care in an efficient manner. As such, Section 2118 of SB 225 would create unnecessary barriers to accessing and maintaining treatment for persons with addiction.

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September 20, 2022

To: The Honorable Tina PicketChair, House Insurance Committeestate capital, Harrisburg, Pa 17120

Re: PSAM’s objection to Section 2118 of SB 225

Dear Chairman Pickett,

In favor of Pennsylvania Society for Addiction Medicine (PSAM), the medical society representing physicians and clinicians Pennsylvania who specialize in addiction prevention and treatment, we are writing to express our opposition to Section 2118 of SB 225. This provision would allow insurers to introduce prior authorization restrictions for addiction treatment drugs (MAT) beyond the initial prescription. It would also allow insurers to designate preferred drugs when multiple drugs are available for treatment. As opioid addiction and the overdose epidemic continue to severely affect our Commonwealth, we cannot afford to impose additional treatment barriers and limit patient access to life-saving medicines.

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PSAM is dedicated to improving the availability of evidence-based addiction treatment end-to-end Pennsylvania. To that end, we advocate for a government addiction treatment system that provides better access for all Food and drug management (FDA) approved drugs to treat addiction. As such, we are very concerned about Section 2118 of SB 225, which would add significant barriers to physicians and patients engaging in addiction treatment. When a patient presents for treatment, it is imperative that physicians can act quickly and be able to view all treatment options without outside interference. Pre-approval and preferred medication guidelines limit this ability, causing delay and confusion, and ultimately leading to poorer patient outcomes./i

That Administration of Substance Abuse and Mental Health Services (SAMHSA) states that MAT has been shown to improve patient survival, increase treatment duration, reduce illicit opiate use and other criminal activity in people with substance use disorders, and increase patients’ ability to find and maintain employment./ii

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However, when onerous prior approval requirements delay their prescription, physicians cannot offer MAT as quickly as needed to effectively treat their patients./iii In fact, a recent survey of physicians found that 93% of them reported delays in treatment due to prior approvals 82% indicated that prior approval may lead to treatment discontinuation./iv Such delays and uncertainties significantly impact patient outcomes. In addiction treatment, a delay of just one day can make the difference between life and death. A day is enough time for a patient to return to use, overdose, or have a myriad of other experiences that can adversely affect their outcome. By allowing insurers to enforce pre-approval for MAT beyond initial coverage, SB 225 puts addiction patients at a disadvantage and takes steps in the wrong direction in the struggle to access and retain treatment.

Because of the deleterious consequences of non-evidence-based usage controls, and consistent with sound medical care, decisions about the type, modality, and duration of treatment should remain the responsibility of board-certified physicians and their patients. In addition, arbitrary limitations on treatment duration, drug dosage, type of medication, or level of care that are not supported by medical evidence are not appropriate and can be particularly detrimental to the well-being of the patient and their community. Because these non-evidence-based restrictions are so harmful, they should not be enforced through law, regulation, or health insurance practice. Therefore, PSAM opposes the inclusion of harmful prior approvals and policies for preferred drugs in this bill.

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We urge your committee to amend Section 2118 to remove all forms of prior authorization for life-saving MAT. Thank you for the opportunity to speak on this important issue and please feel free to contact us at our personal emails or mobile phones anytime we can clarify the negative implications of Section 2118 in the written form or assist your colleagues in addressing them to understand.

respectful,

Wilhelm SantoroMD, FASAM, President of the Pennsylvania Society of Addiction MedicineHead, Addiction Medicine Section, health of the towerC: (610) 223-5949, E: [email protected]

James R. LatronicaDO, FASAM, Chair of Public Policy, Pennsylvania Society for Addiction Medicine, assistant Prof. for Psychiatry and Family Medicine, University of Pittsburgh School of MedicineC: (330) 416-4077, E: [email protected]

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Footnotes:

I Andis Robeznieks. (2022). Why pre-approval is bad for patients and bad for business. American Medical Association. https://www.ama-assn.org/practice-management/priorauthorization/why-prior-authorization-bad-patients-and-bad-business

ii Administration of Substance Abuse and Mental Health Services. (2022). Medication Supported Treatment (MAT). SAMHSA.gov. https://www.samhsa.gov/medication-assisted-treatment

iii Legal Action Center. (2015). Confronting an epidemic: Cases for removing barriers to drug treatment for heroin and opioid addiction. https://www.lac.org/resource/confronting-an-epidemic-the-case-for-eliminating-barriers-to-medication-assisted-treatment-of-heroin-and-opioid-addiction

IV American Medical Association. (2022). 2021 AMA Physician Survey with Prior Permission (PA). American Medical Association. Retrieved September 19, 2022from https://www.amaassn.org/system/files/prior-authorization-survey.pdf

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Original text here: https://www.asam.org/news/detail/2022/09/20/psam-opposes-prior-authorization-on-evidence-based-addiction-treatment





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