In the midst of the worst overdose epidemic in US history, addiction medicine specialists say a bureaucratic hurdle is adding to the difficulty of getting people in treatment: an insurance industry tactic called “prior authorization”.
Loathed by doctors of all stripes, prior authorization requires healthcare providers to seek permission from insurance companies before they prescribe a treatment. Doctors in addiction medicine said the requirement is both unnecessarily burdensome and could cost lives.
“We have patients who are having overdoses once a month because of the fentanyl being in the drug supply,” said Dr Alain Litwin, a clinical researcher and executive director of the Prisma Health Addiction Medicine Center in South Carolina. “This is the crisis of our time – overdose rates are rising every year”.
In 2021, the most recent year for which data is available, roughly three-quarters of the 107,000 people who died of an overdose had an opioid in their system, approximately 80,000 people.
An estimated 2.5 million Americans 18 and older are believed to suffer from opioid use disorder, the clinical name for an addiction to opioids, illicit or prescribed. People with opioid use disorder suffer “alarmingly high” rates of death and health conditions, research has found.
That risk of death can be halved with use of the gold-standard therapies: medication-assisted treatment with buprenorphine, methadone or naltrexone. However, four out of five Americans addicted to opioids are still not in treatment.
Prior authorization has targeted buprenorphine in particular. Insurance companies can set qualification criteria that require patients seeking treatment for opioid use disorder to submit to urine drug tests, require pill counts, set dosage limits, and mandate patient education or counseling. It also requires doctors to fill out lengthy forms and wait for approvals. All of which, doctors said, makes patients feel stigmatized and