Bills introduced in the House last week and in the Senate on Jan. 22 would prohibit insurance companies or Medicaid from requiring pre-authorization before approving medication-assisted treatment, or MAT.
The bill as introduced by Rep. Ann Pugh, D-South Burlington, is intended to remove any potential barriers between someone with a substance abuse problem and treatment.
Pugh said she began with “what is obvious,” she said.
“I have spent a good portion of my legislative career looking at trying to address prevention as well as treatment. This is a serious problem and access and money, or insurance coverage, is a problem. When I discovered that something that was being recommended by the medical community and there was the possibility that individuals were not getting the MAT treatment because of hurdles in the insurance industry, I wanted to put in a bill,” she said.
A February 2017 article on the American Medical Association, or AMA, website urged action to end pre-authorization.
Dr. James Madara, the AMA executive vice president and CEO, sent a letter in 2017 urging attorney generals in the U.S. to get involved after Attorney General Eric Schneiderman released the results of an investigation that found some patients had their opioid abuse treatment delayed because almost 8 percent of MAT coverage requests in 2015 and the first half of 2016 were denied by the insurer.
“We need to remove any and all barriers to providing care for substance-use disorders,” Madara wrote.
Commissioner of the Department of Vermont Health Access Cory Gustafson, the department which manages Vermont’s publicly funded health insurance programs, said he expected to speak with legislators about the bill. He said Vermont “fully have embraced (MAT) as the best way to treat addiction.”
However, he said he would want to look more closely at the goals of the bill and the possible effect. He said his department was not aware that Vermonters were having a problem accessing treatment because of the pre-authorization requirement.
He said he was also concerned that Vermont would lose the rebates they receive on certain drugs, like suboxone, if they eliminated the pre-authorization as a way of managing its pharmacy list.
Gustafson said the early projection, as of Friday, was that the state could spend $3.5 million more if the pre-authorization option was removed.
Pugh said she believed that if a medical provider working with his or her patient believed MAT was the best treatment for the patient's addiction, the medical provider should be able to arrange MAT as soon as possible.
“We're just trying to get the private insurers in the game,” Pugh said.
The Senate bill uses the same language as the House bill. The Senate bill has been referred to the Senate Committee on Health and Welfare while the House bill has been referred to the House Committee on Human Services for which Pugh is chairwoman.
Sara Teachout, a spokeswoman for Blue Cross/Blue Shield of Vermont, said the insurer did not oppose the bill. She said Blue Cross/Blue Shield does not require pre-authorization now.
“We support these programs and we offer more services than I think some other insurance companies do,” she said.
Pugh is currently the only sponsor for the House bill.
“I did not ask anyone. I'm sure if I had spent the time going around and asking or putting it out on email to the body that I was introducing this bill, I have no doubt there would have been lots of individuals who would have signed onto it,” she said.
Pugh said Vermont Drug Prevention Policy Director Jolinda LaClair would be talking to the Human Services committee next week. She said LaClair would be talking about Gov. Phil Scott's Opioid Coordination Council but Pugh said LaClair would be notified during those meetings about the policy initiatives the house is developing to address the opioid crisis.
LaClair said on Friday she didn't know enough the proposed bills to address them directly.
“I want to say that Gov. (Phil) Scott has worked hard to ensure that all people have access to medication-assisted treatment across the state. We have a nationally renowned system for treatment for opioid use disorder and that's Vermont's hub and spoke system of treatment,” she said.
Pugh said she hopes the bill would be supported but added, “We haven't even begun the discussion.”