Pennsylvania Updates Medication-Assisted Treatment (MAT) Prior-Authorization Requirements for Substance Use Disorder

March 2018 ~

Pennsylvania has announced plans to remove a pre-authorization requirement for Medicaid recipients to access Medication-assisted treatments (MAT) for opioid/substance abuse addiction.

FDA-approved treatments, known as medication-assisted treatment, or MATs, when combined with counseling and behavioral therapies, are proven strategies for reducing addiction relapse and improving the chance for recovery. However, it has been found that prior authorization rules often delay MAT, sometimes for up to 24 hours, when people need treatment the most. In response, on March 1st, the Governor announced the state’s Medicaid program will no longer require prior authorization to cover MAT for opioid use disorder.

“I am here to announce that, going forward, my administration will be ending policies that delay access to treatment for those suffering from opioid use disorders in our Medicaid program,” Governor Wolf said. “Pennsylvania’s Medicaid program will be waiving prior authorization requirements for evidence-based opioid use disorder treatments.”

The announcement is part of the state’s larger efforts to fight the heroin and opioid abuse epidemic. In January, Governor Wolf declared a public health emergency via a 90-day disaster declaration in Pennsylvania to bring together resources and focus efforts.

In his declaration, the governor challenged all state agencies to find innovative solutions to eradicate heroin and opioid addiction. He encouraged them to focus on 13 initiatives. Additionally, Governor Wolf implemented 45 centers of excellence that will provide treatment for 11,000 people with substance abuse disorder.

The Governor says, over the coming months, he will reach out to every commercial payers and health care organization managed by Medicaid and ask them to begin discussion about similar policies to create consistency across the health care industry in Pennsylvania.

The administration will work with Medicaid managed care organizations to fully implement the new policy within 60 days.


Source(s): Commonwealth of Pennsylvania; USA Herald; The Hospital Healthsystem Association of Pennsylvania; The Spirit;