Starting December 1, patients on Indiana’s Healthy Indiana Plan will have an easier time getting certain opioid addiction medications. The four insurers that manage plans for Indiana’s Medicaid program, HIP 2.0, are eliminating an administrative hurdle that can cause patients to wait days to receive their prescription, leaving them vulnerable to relapse and overdose.
On Friday, the Indiana Medicaid Drug Utilization Review Board agreed to remove prior authorizations for preferred versions of the addiction treatment medication buprenorphine, often formulated an abuse-deterrent component called naloxone.
Prior authorizations require providers to get approval before insurers will pay for a prescription. The change will spare providers from dealing with this labor-intensive administrative process every time they need to prescribe a common addiction medication.
“We are having relapses,” said Dr. Carol Ott, professor of pharmacy at Purdue University and chair of the committee that approved the changes. “We’re in the midst of this crisis, so this will hopefully streamline treatment.”
Representatives from the four insurers that operate Indiana’s Medicaid program — Anthem, CareSource, MDWise and MHS — presented the plan to the board. They explained they would make generic tablets the preferred form of the medication, rather than the brand name Suboxone films currently preferred by most HIP 2.0 insurers. The films can be sold on the street and are often confiscated in prisons and jails because the strips are easy to smuggle in.
Under the new rules, which begin December 1, film versions of the medication would still require a prior authorization.
Many addiction specialists in Indiana have criticized prior authorizations on buprenorphine for years, because they hamper patients’ access to a drug that can literally save their lives. And for clinicians like Dr. Andy Chambers, an addiction psychiatrist at the Indiana University School of Medicine, the change is welcome.
“That’s awesome. I’m really glad to hear this,” said Chambers.
Following these rules was labor-intensive for physicians. New prescriptions or changes in dosage often require a back and forth with the insurer, resulting in costly delays for patients and providers.
Chambers said as recently as Friday he even tried to reduce the dose for a patient, and ran into complications with the insurance company. “I’m trying to get them off the med, and they’re trying to block me,” he said. “I end up spending hours, and it financially penalizes my treatment system.”
“I’m glad they acted on it,” he said of the board decision.
The change is part of a national movement to remove barriers to treatment for those suffering from addiction. Last year, New York Attorney General Eric Schneiderman reached a settlement with the insurance company Cigna to remove prior authorizations for buprenorphine medications. Months later, Schneiderman announced a deal with Anthem, although the changes did not impact Indiana’s Medicaid program.
Dr. Camila Arnaudo, an addiction psychiatrist who teaches at the Indiana University School of Medicine in Bloomington, said she thinks the insurers should remove prior authorizations for all buprenorphine products, but she was happy with the progress.
“Honestly, it’s kind of crazy that it wasn’t like this before,” she said. Many prescription painkillers, largely blamed for the opioid epidemic, do not require a prior authorization, she said.
“But then to get the thing that could get you un-addicted, you have to go through all these hoops.”
Arnaudo said that she thinks making buprenorphine tablets the preferred drug, rather than the film, will make diversion less likely. (Patients currently on the film would be given 90 days to switch, or receive approval to stay on the film.)
Both doctors agreed that making the medication easier to prescribe by removing prior authorizations will make addiction treatment more appealing and ultimately bring in more providers to help combat the opioid epidemic.
“I think this is going to make a big impact on the willingness of providers to get in on the game,” said Arnaudo.
This story was produced by Side Effects Public Media, a news collaborative covering public health.