Health insurer policy change applies to buprenorphine

Health insurer Cigna Corp. will stop requiring that patients and doctors jump through extra hoops known as prior authorization to receive coverage of a medication to treat opioid addiction, under a settlement with New York state’s Attorney General, the attorney general’s office said.

Cigna is making the change nationwide after New York State Attorney General Eric Schneiderman requested information on the insurer’s coverage policies “to address concerns about barriers to treatment,” Mr. Schneiderman’s office said in a statement. Cigna required doctors to answer “numerous questions” about the patient and sometimes wait “several days” for coverage approval, the statement said.

“Removing barriers to proven effective life-saving treatment is an important component to address New York’s and the nation’s opioid addiction crisis,” Mr. Schneiderman said in the statement. “Other health insurers should take notice of Cigna’s actions to remove access barriers to treat opioid dependency.”

A Cigna spokeswoman said the insurer agreed voluntarily to end prior authorization requirements for drugs used to treat opioid addiction in its commercial plans, which are those provided to employers and individual consumers. “This will help make it easier for our customers to access coverage for the medications they need,” she said, adding that Cigna aims to reduce opioid use among its customers by 25% in three years.

Mr. Schneiderman’s office said the policy change applies to buprenorphine, a medication that eases cravings for heroin and other opioid drugs. Buprenorphine partially activates the same cellular receptors in the brain that heroin does, thus blocking the painful withdrawal symptoms that stop many addicts from quitting illegal opioids.

Clinical studies have shown buprenorphine reduces illicit opioid use and helps people stick with counseling and other forms of treatment, according to the Substance Abuse and Mental Health Services Administration, or Samhsa.

Buprenorphine can produce euphoria, though at weaker levels than heroin does, according to Samhsa. Some public health officials and doctors have been troubled by buprenorphine’s trade on the black market by addicts seeking to stave off withdrawal or by people seeking a high.

To try to control this black-market trade, the federal government requires doctors to obtain authorization to prescribe buprenorphine, which is a controlled substance. Earlier it mandated that each authorized doctor could treat no more than 100 patients, but this summer the Department of Health and Human Services raised that cap to 275 patients to allow more people to get treated.

John Kelly, an associate professor of psychiatry in addiction medicine at Harvard Medical School, called Cigna’s policy change “an extremely positive development that will literally be lifesaving.”

“Removing the pre-authorization barrier allows providers to take advantage of an often narrow window of opportunity when someone addicted to opioids is open to beginning treatment,” he said.

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