As opioid-related overdoses continue to increase in the United States, Aetna has ended the preauthorization requirements on all buprenorphine products, used to treat opioid addiction. Ending the requirement for buprenorphine will increase access to treatment of an addiction.
The changes will go into effect in March 2017 and affect commercial plans.
More than six out of 10 drug overdose deaths involve an opioid, according to the United States Centers for Disease Control and Prevention (CDC). The number of overdose deaths in the United States involving opioids has quadrupled since 1999. Nationwide, more than 500,000 people have died from a drug overdose involving an opioid from 2000 to 2015, according to the CDC.
CDC: 91 people in the U.S. die every day from an opioid overdose
Prescription opioids, such as oxycodone and hydrocodone, are used to treat pain in patients. Fentanyl is a popular synthetic opioid used to treat pain, but can also be used to intensify the effects of other drugs, such as heroin, according to the CDC.
Streamlining addiction treatment benefits patients
The medication-assisted treatment process for opioid addiction combines behavioral therapy and medications.
Previously, a doctor had to receive authorization from the insurer before prescribing buprenorphine to a patient. Celynda Tadlock, vice president of Clinical, Product and Customer Experience at Aetna, said the authorization could take between 24 to 48 hours.
As part of the preauthorization process, an insurer had to verify whether the person was in a treatment program, such as rehabilitation or counseling.
A recent study by Aetna’s waste, misuse and abuse programs found patients that didn’t receive treatment for opioid addiction used more medical resources. Aetna’s Pharmacy and Therapeutics Committee then held an ad-hoc vote in February to lift the preauthorization requirements.
Study: 43 percent of people receiving treatment filled an opioid prescription
“We want to prevent addiction,” Tadlock said, “but if it happens, we also want to be an advocate to help with treatment.”
After reviewing Aetna’s medication-assisted treatment policy, the company’s Office of the Chief Medical Officer, Aetna Behavioral Health and Aetna Pharmacy, recommended the removal of preauthorization requirements on all buprenorphine products.
“This streamlines the process for prescribers and makes it easier for members that need this medication to get the medication,” said Mark Friedlander, M.D., M.B.A., chief medical officer for Aetna Behavioral Health.
Monitoring helps to fight against potential abuse
A recent study published in the Addiction Journal found a large portion of patients who are receiving or received treatment for opioid addiction still fill prescriptions for opioids. Out of 38,096 people, researchers found 43 percent filled an opioid prescription during treatment and 67 percent filled a prescription after treatment.
Friedlander emphasized there are measures in place at Aetna to prevent abuse. Quantity limits prevent a member from receiving large amounts of buprenorphine, he said.
And there are additional services at Aetna to help identify possible abuse.
“There is a way to check if a person is using buprenorphine and narcotics simultaneously and that indicates they are not trying to get into recovery,” he said. “If someone is at risk, we can engage them with outreach and try to better understand what’s going on.”
Tadlock said the company can monitor for duplicate therapies. Aetna’s “Controlled Substance Use Program” identifies members exhibiting potential prescription drug misuse or abuse. Those members and their prescribing doctors are notified of the concern.
The company also created an enterprise-wide opioid task force. The task force examines ways for the company to partner with providers and pharmacies to provide doctors with data on opioid prescribing practices, so they can understand how their prescribing patterns compare to those of their peers.
In 2016, Aetna’s Chief Medical Officer Harold L. Paz, M.D., M.S., sent a letter to nearly 1,000 “super-prescribers,” doctors identified for writing opioid prescriptions at a higher rate than their peers.
People need to know about treatment
While lifting the preauthorization requirement on buprenorphine products makes it easier for members to receive treatment, Friedlander said that more people need to be aware that medication-assisted treatment is an option, and may be available at a reduced cost.
Medication-assisted treatment is categorized as chronic medication at Aetna. In some plans, there may be a cost share for members who are on chronic medication.
“There is a reduced cost share for folks who have to take blood pressure medication every day. We don’t want to make it too difficult for them financially to adhere to their medication program,” Friedlander said. “We now put opioid product dependence in the same category to make it easier.”