States Remove Barriers to Opioid Use Disorder Medications

A recent study from Tulane University reveals a significant shift in state policies aimed at easing access to medications for those suffering from opioid use disorder. According to the research published in Health Affairs, as of 2023, a total of 22 states have enacted laws that prohibit private insurance plans from requiring prior authorization for these medications. This marks a dramatic increase from just two states in 2015, reflecting a growing commitment to address the ongoing opioid crisis.

The lead author of the study, Allison Ju-Chen Hu, an assistant professor of health policy and management at the Celia Scott Weatherhead School of Public Health and Tropical Medicine, emphasized the importance of these legislative changes. “Prior authorization is a major barrier to care and removing it helps patients start treatment faster,” Hu stated. The study specifically analyzed state laws from 2015 to 2023, focusing on private insurance, as individuals with private coverage often face more hurdles than those enrolled in Medicare or Medicaid.

Over one-third of those with opioid use disorder are covered by private insurance. Medications used to treat this condition include methadone, buprenorphine, and naltrexone. If prior authorization is denied, patients may still receive the medication, but they often have to pay out of pocket or forgo treatment. Hu pointed out that “having coverage doesn’t necessarily guarantee access to needed medications.”

While seven states have fully banned prior authorization for all medications related to opioid use disorder, an additional 15 states have implemented partial bans. These partial bans may still permit prior authorization under certain circumstances, such as specific drug types or prescription lengths. Notably, four states—New York, Arkansas, Colorado, and Missouri—have strengthened their laws to eliminate these restrictions.

The trend indicates an increasing awareness of the opioid crisis among legislators and the public. Even partial prohibitions can serve as a foundation for broader reforms in healthcare access. Additionally, the study highlighted that eight states have extended prior authorization prohibitions to naloxone, a medication crucial for reversing opioid overdoses. Naloxone became available over the counter in 2023, although having insurance significantly reduces the out-of-pocket cost for consumers.

The opioid epidemic continues to have devastating effects, with approximately 80,000 Americans dying from drug overdoses involving opioids in 2023. Hu expressed hopes that this legal analysis will pave the way for future studies on the effectiveness of prior authorization bans, insurer compliance, and overall access to medications for opioid use disorder.

“With proper enforcement, patients in these states should face fewer delays and have an easier time getting the medications they need,” Hu stated. She called for further research to evaluate how effectively these laws are being implemented and whether they are positively impacting treatment outcomes.

As states continue to take action against the barriers associated with opioid use disorder medications, the focus now shifts to ensuring these laws translate into real-world improvements for patients in need.