Opioid-treatment measure moves forward
House panel unanimously favors removing prior authorization for doctors
A bill that seeks to eliminate roadblocks to treating opioid addiction sailed through an Arkansas House committee Wednesday despite opposition from the state’s Department of Human Services.
The House Insurance and Commerce Committee voted without opposition to support House Bill 1656, sponsored by Rep. Deborah Ferguson, D-West Memphis.
The bill states that health insurers, including Medicaid, can’t require physicians to get permission from the insurer to prescribe certain medications — Suboxone, burenorphine, naloxone, methadone and naltrexone — used to treat opioid addictions. Insurance companies use the approval, known as prior authorization, to control costs and ensure patients need the medicine.
“It just says that the doctor doesn’t have to jump through hoops to get a prior authorization because that delays treatment,” Ferguson told the committee Wednesday.
The medications are often used in conjunction with behavioral therapy to block opioid-withdrawal symptoms, a practice called medication-assisted treatment.
The bill also states that the charge for medication-assisted treatment should be “on the lowest-cost benefit tier” of an insurer’s payment schedule.
Ferguson said many states are removing prior-authorization requirements to address the opioid epidemic. Similar legislation was proposed in Kentucky, Colorado, Maine and Virginia. Pennsylvania insurers have already agreed to remove the requirements, according to the American Medical Association.
Arkansas had the second-highest rate of opioid prescriptions in the country in 2017 at 105.4 prescriptions per 100,000 people, according to the U.S. Centers for Disease Control and Prevention. Only Alabama was higher with 107.2 per 100,000.
Ferguson added that many insurance companies have already removed the authorization requirements, but said Medicaid causes patients the most problems. She said she’d been working with the state Department of Human Services for over a year to improve on what she called in a later interview “draconian practices.”
Dr. Gene Shelby, who runs a Hot Springs clinic where he treats addiction, told the committee of a patient who was blocked from getting her medication by Medicaid. He said he had been treating her for several years, and she was seven months’ pregnant at the time.
The patient missed a couple of weeks of Narcotics Anonymous meetings because of her pregnancy, and Medicaid denied his request for her prescription, Shelby said. He said he spent hours on the phone pleading for the prescription.
“This is very safe medicine,” Shelby said. “It saves people’s lives and helps people live normal lives.”
Two Human Services Department representatives spoke against the bill, citing concerns about removing checks that could allow the medications to be sold on the streets.
“I think if we just open the door without any PAs [prior authorizations], without any guidelines, and I’ll go further on that, it opens a door because we see right now on the street Suboxone being abused,” said state Drug Director Kirk Lane.
The process of getting treatment has been too burdensome in the past, but the Human Services Department is working to fix the problem, he said. The department wants to make sure doctors are properly trained in how to use the treatment and are incorporating counseling as well as medicine, he said.
The Human Services Department began adjusting its prior-authorization review process in recent months and is finalizing new forms, department spokesperson Marci Manley wrote in an email to the Arkansas Democrat-Gazette.
The goal is to reduce barriers to patients and “administrative burden” on physicians, she said.
She added that “DHS is publicly funded and bears a responsibility to our beneficiaries and to taxpayers to ensure appropriate use and proper safeguards. In that spirit, Medicaid utilizes prior authorization processes to help prevent waste, fraud and abuse.”
Ferguson said that she’d learned that the department was approving “99 percent” of prior-authorization requests, which she said means that the primary result of requiring the paperwork was simply delaying drugs.
In 2018, the state paid for 3,775 “Suboxone-type products,” and approved the “vast majority” of requests. Those not approved were for non-opioid use disorders or were requested by doctors who hadn’t finished medication-assisted treatment training, Manley said.
A couple of legislators echoed Lane’s concern that patients selling the treatment drugs would become a problem.
“My concern is personal. My son just came out of his fifth stint of rehab, and he’s been on Suboxone before,” said Rep. Mark Lowery, R-Maumelle.
Lowery added that he had never asked his son whether he sold the Suboxone to buy more heroin.
Shelby said that people don’t generally get high from Suboxone and that if someone was buying the drug on the streets, it was likely because they couldn’t get it legally and needed it to prevent withdrawals.
“I don’t want us to get distracted with what this bill is not about,” Ferguson said. “This bill is about not requiring doctors to send in all this paperwork.”
David Ivers, the attorney who represents the Arkansas Medical Society, also spoke in support of the bill and reiterated Ferguson’s earlier statement that Medicaid was “the biggest problem.”
“Any delay will result in withdrawals for patients,” Ivers said. “If they can’t get the drugs, they will be back out on the streets.”