Suboxone and Prior Authorizations from Insurance

Opioid narcotics are highly effective substances used to treat varying degrees of pain in patients around the world. There is, arguably, no other form of drugs that can mitigate symptoms of pain as well as opioids, such as oxycodone (OxyContin ®) and hydrocodone (Vicodin ®). The efficacy of such drugs, and mandates on pain management in the United States, resulted in the most severe drug epidemic in the history of mankind. And America is ground-zero.

You are probably aware that in recent years there has been a major push from both health experts and lawmakers to rein in the American opioid addiction epidemic. Efforts which came in the form of legislation and prescribing guidelines, as well as the creation of prescription drug monitoring programs (PDMPs). The efforts had, in many ways, the intended effect—leading to a serious reduction in prescriptions written, the closing of pharmacies and clinics and prosecuting certain doctors. However, given that the crux of ending the epidemic is helping the millions of opioid-dependent Americans get the treatment they need—it is fair to say that much more work is needed.

Most of the people charged with tackling the opioid epidemic agree that we can no longer hold on to the misguided belief that we can arrest addiction away. Even if doctors stop prescribing opioids outright, patients will find their drugs on the street. If they cannot afford prescription opioid street prices, they will typically opt to use heroin. A cheaper and stronger alternative. Law enforcement could arrest every dealer in the country, but others will fill the void in their absence.

The point, which you have probably gathered by now, is that addiction treatment is the best weapon. Unfortunately, it has been a real struggle for some people to get the help that they need. The result being this crisis is now in uncharted water, at least in some cases. The National Institute on Drug Abuse (NIDA) has been urging more doctors to prescribe Suboxone (Buprenorphine), a drug that can greatly alleviate the pain typical of opioid withdrawal. The drug, when used within a maintenance model has been shown to reduce the risk of relapse.

The call to make Suboxone more accessible has been somewhat difficult to heed, for a number of reasons: 1) Few doctors are licensed to prescribe the drug. 2) Doctors can only prescribe the drug to a set number of patients. 3) Insurance companies have been slow to offer coverage for Suboxone or have policies that make it difficult for patients to get the drug.

Fortunately, the third issue appears to be coming to an end. Starting in March one of the top insurance providers will make it easier for patients to get Suboxone, making them one of three to change their coverage in recent months, NPR reports. Aetna will no longer require doctors to seek prior authorization from the insurance company before they prescribe Suboxone. This is a big move that should help thousands of Americans.

With addiction treatment, and the decision by a patient to seek it, time is of the utmost importance. The decision to seek help is often times fleeting. If doctors can't provide help immediately, reneging on one’s decision typically follows. The Aetna policy change should mitigate the risk of an addict changing their mind.

"If someone shows up in your office and says, 'I'm ready,' and you can make it happen right then and there ― that's great," said Dr. Josiah Rich, a professor of medicine and epidemiology at Brown University. "If you say, 'Come back tomorrow, or Thursday, or next week,' there's a good chance they're not coming back.”