A new study in the Journal of the American Medical Association finds that Medicare prescription drug plans that remove prior authorization for common opioid use disorder medications — such as buprenorphine and naloxone — saw an increase in the use of those medications as well as a decrease in hospitalizations and emergency department visits for all medical conditions.
Conducted by researchers at RTI International, a nonprofit research institute, the study also found that the cost of increased opioid medication usage was more than offset by savings from reduced hospitalizations and emergency department visits.
Prior authorization can prevent patients from getting quick access to life-saving medications. But many payers still require prior authorization for opioid use disorder medications, despite expert calls to remove this requirement.
“This study shows that removing barriers to medications for the treatment of opioid use disorder is not only important from a public health perspective, but also has an economic benefit. Going forward, health plans should account for the impact of prior authorization on total health care costs, not just prescription drug costs, in formulary decisions,“ said Tami Mark, PhD, lead author of the study and Senior Director of Behavioral Health Financing and Quality Measurement at RTI.
Ellen Weber, Vice President of Health Initiatives at the Legal Action Center, a nonprofit law and policy organization working with RTI, noted that this research further demonstrates that there is no clinical or economic justification for imposing prior authorization on opioid use disorder medications. Removing administration barriers will help save dollars and lives.
These findings help strengthen the case that removing prior authorization for OUD medications leads to better health and economic outcomes.