States Remove Hurdles for Opioid Use Disorder Medications

A recent study from Tulane University indicates significant progress in state-level legislation aimed at improving access to medications for individuals with opioid use disorder. As of 2023, 22 states have enacted laws that prohibit private insurance companies from requiring prior authorization for these medications. This marks a notable increase from just two states in 2015.

The findings, published in Health Affairs, highlight a growing recognition among state legislators regarding the opioid crisis. According to Allison Ju-Chen Hu, the study’s lead author and assistant professor at the Celia Scott Weatherhead School of Public Health and Tropical Medicine at Tulane, “This signals a positive trend that states are making legislative efforts to address the opioid crisis.” Eliminating prior authorization is crucial, as it often serves as a significant barrier to timely care and treatment.

The study analyzed legislation from 2015 to 2023, focusing on private insurance, where patients often face prior authorization more frequently than those with Medicare or Medicaid. Notably, more than one-third of individuals with opioid use disorder are covered by private insurance. Medications commonly prescribed include methadone, buprenorphine, and naltrexone. If prior authorization is denied, patients may have to pay out-of-pocket or forgo treatment altogether, underscoring the importance of accessible coverage.

Among the states that have taken action, seven have completely banned prior authorization for all medications used to treat opioid use disorder. In addition, 15 states have implemented partial bans, which still allow prior authorization in certain circumstances, such as for specific drug types or prescription lengths. Notably, four states—New York, Arkansas, Colorado, and Missouri—have subsequently strengthened their regulations to further remove these barriers.

The study also noted that eight states have expanded their prior authorization prohibitions to include naloxone, a life-saving medication that reverses opioid overdoses. Since 2023, naloxone has been available over the counter, although insurance coverage can significantly reduce out-of-pocket costs. In 2023, approximately 80,000 Americans died from drug overdoses involving opioids, indicating the urgent need for effective treatment options.

Hu emphasized that the legislative changes reflect a growing awareness of the opioid crisis among both the public and lawmakers. She noted that even partial prohibitions on prior authorization could serve as a foundation for broader reforms. “With proper enforcement, patients in these states should face fewer delays and have an easier time getting the medications they need,” Hu stated.

Looking ahead, she hopes the analysis will pave the way for future research on the effectiveness of these laws and their impact on access to treatment for opioid use disorder. “Future research should examine how well these laws are working in practice and whether they’re helping more people stay in treatment,” Hu added.

The findings underscore the importance of continuous efforts to enhance access to care for those affected by opioid use disorder, an ongoing public health challenge.