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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To: The Honorable
Re: PSAM’s objection to Section 2118 of SB 225
In favor of
PSAM is dedicated to improving the availability of evidence-based addiction treatment end-to-end
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.
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.
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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
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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