Pubdate: Thu, 19 Jan 2017
Source: USA Today (US)
Copyright: 2017 USA TODAY, a division of Gannett Co. Inc


"We should be doing whatever we can to make lifesaving treatments
accessible to those suffering from addiction," said New York Attorney
General Eric Schneiderman.


New York Attorney General Eric Schneiderman speaks during a press
conference on September 23, 2016 in New York City.(Photo: Drew Angerer,
Getty Images)

Anthem, the nation's second-largest insurance company, has ended its
policy of pre-authorizations for drugs to treat opioid use disorder
following an agreement with New York Attorney General Eric Schneiderman,
his office said Thursday.

The agreement, which affects Anthem plans across the United States and
Empire Blue Cross Blue Shield customers in New York, followed an
investigation into Empire's practices in New York.

A similar deal was reached between the attorney general's office and the
insurer Cigna in October.

"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.

Anthem announced Wednesday that it is working with its affiliated health
plans to double the number of consumers who receive behavioral health
services as part of medication-assisted therapy (MAT) for opioid
addiction. Anthem Blue Cross and Blue Shield in Ohio also said it hopes to
reduce the amount of opioids given to members by 30% from their peak
levels by the end of 2019.

MAT drugs usually contain buprenorphine and naloxone and can be prescribed
and given to patients in doctors' offices as long as the physician has the
appropriate certification and federal license.

While methadone and buprenorphine both reduce cravings and stabilize the
brain so the person can think clearly and benefit better from counseling,
methadone has to be administered in highly-structured clinics.

Psychosocial therapy and medical treatment are also recommended for
patients receiving MAT.

Anthem required doctors to submit prior approval forms to request coverage
for MAT to answer "numerous questions about the patient's current
treatment and medication history," according to Schneiderman's office. The
doctors had already gotten specific training regarding MAT and had federal
authorization to prescribe drugs.

Doctors and advocates say often time-consuming pre-authorizations for MAT
increase the risks of overdose and death. Schneiderman's office noted
Anthem didn't require patients to go through the time consuming
pre-authorization process for highly addictive pain medications including
fentanyl or oxycodone.

The company also doesn't require prior authorizations for most of the
drugs it covers for medical conditions. New York and federal mental health
parity laws require health plans to cover mental health and substance use
disorder treatment the same way they cover treatment for physical

The investigation also found Empire BCBS denied nearly 8% of overall
requests for MAT coverage in 2015 and the first half of 2016. This led to
significant delays in patients obtaining treatment for addiction if they
received it at all, the office said.

Physician Teresa Koeller, St. Elizabeth Healthcare medical director of
addiction medicine in Northern Kentucky, called the announcement "huge."

"We need to get prior-authorizations for everybody," she said. "This will
definitely help."

New patients may not realize they have to call the doctor's office for a
new prior-authorization, she says.

"Patients in early recovery don't have the ability to juggle their lives,"
Koeller said. "They may lack the basic life skills."

Even later, when patients are working on multiple issues, such as
education, job-hunting and paying debts, calling the doctor's office is
put off, Koeller said, which can lead to dangerous delays.

Anthem was actually often more receptive than many insurance companies
when it comes to medication assisted treatment, said Mina "Mike" Kalfas, a
doctor and certified addiction specialist in Northern Kentucky for Christ
Hospital outpatient services.

Mina "Mike" Kalfas, a doctor and certified addiction specialist in
Northern Kentucky for Christ Hospital outpatient services, prepares
Vivitrol for an injection. (Photo: Carrie Cochran, Cincinnati Enquirer)

A few years ago, Kalfas said, Anthem required opioid disorder patients to
start with the pill form of a medication that blocks the effects of heroin
and opioids called naltrexone.

That presents problems: those who are prescribed the pills often stop
taking them, which puts them at risk for overdose, he says. Kalfas was
prescribing injectable naltrexone, which is given in a shot once a month.
That keeps the patients safer for a longer period and allows for accurate
dosage, he said.

Anthem said it determined in the last year that only about 16 to 19% of
its members taking MAT medications for opioid use disorder also were
getting the recommended in-person counseling. Last year three
Anthem-affiliated health plans in the northeast began working on
improvements to its medical coding and reimbursement for psychiatrists and
non-psychiatrist medical doctors who are certified to support MAT
treatment. Anthem is also working to attract more doctors who aren't
psychiatrists to help ensure members get counseling while receiving their
drug therapy.

"While we've made progress, there are too many still suffering," said
Schneiderman, "We're committed to continue working with health insurers
across the country to eliminate barriers to lifesaving opioid addiction
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