Pennsylvania Seven Insurers Remove Prior Authorization Requirements for SA Treatment

October 2018 ~

Seven Pennsylvania insurers have agreed to remove prior authorization requirements for substance abuse treatment in Pennsylvania.

Insurers Aetna, Capital BlueCross, Geisinger, Highmark, Independence Blue Cross, UPMC, and UnitedHealthcare, recently reached an agreement with the Commonwealth of Pennsylvania to remove the coverage restrictions and include a broader range of medications to treat substance use disorders on the lowest cost-sharing tier.

The state’s agreement will align prior authorization limits applicable to large commercial plans for medication-assisted treatment (MAT) access with those already used by both the state’s Medicaid fee-for-service and managed-care programs.

Under the agreement, health insurers will cover at least one buprenorphine-naloxone product; methadone; injectable and oral forms of naltrexone, which blocks the effects of opioids; and the nasal form of the overdose-reversal drug naloxone without pre-approval. Insurers also will provide MAT coverage at the lowest patient cost tier on the plan’s pharmacy benefit.

The agreement will apply to individual, small-group and large-group fully insured plans. Employer-funded plans are not included in this agreement.



Source(s): Modern Healthcare; HMA Weekly Roundup October 17, 2018;