States Act to Ease Access to Opioid Use Disorder Medications

A recent study from Tulane University reveals that over the last decade, an increasing number of U.S. states have taken steps to enhance access to medications for individuals suffering from opioid use disorder. The research, published in the journal Health Affairs, indicates that as of 2023, 22 states have enacted laws that prohibit private insurance plans from requiring prior authorization for these critical medications. This represents a significant rise from just two states in 2015.

Lead author Allison Ju-Chen Hu, an assistant professor of health policy and management at Tulane University’s Celia Scott Weatherhead School of Public Health and Tropical Medicine, described this trend as a positive development in legislative efforts aimed at addressing the ongoing opioid crisis. She emphasized that prior authorization poses a substantial barrier to care, and its removal allows patients to initiate treatment more quickly.

The study conducted a thorough analysis of state laws between 2015 and 2023, focusing on private insurance since individuals with this type of coverage are more likely to face prior authorization hurdles than those enrolled in government programs like Medicare or Medicaid. Approximately one-third of individuals with opioid use disorder are covered by private insurance plans.

Medications prescribed for opioid use disorder, including methadone, buprenorphine, and naltrexone, are essential for treatment. If prior authorization is denied by an insurer, a physician can still prescribe the medication, but the patient must either pay out of pocket or forgo treatment altogether. “Having coverage doesn’t necessarily guarantee access to needed medications,” Hu noted.

Among the states that have moved to eliminate prior authorization, seven have fully banned it for all medications related to opioid use disorder. Fifteen additional states have instituted partial bans, allowing prior authorization in specific instances, such as for certain drug types or prescription lengths. Notably, four states—New York, Arkansas, Colorado, and Missouri—have since strengthened their laws to remove these limitations.

This evolving landscape reflects a growing awareness of the opioid epidemic among both the public and state lawmakers. Hu pointed out that even partial bans on prior authorization can serve as stepping stones toward broader reforms. Additionally, the study highlights that eight states have expanded their prior authorization prohibitions to include naloxone, a critical medication used to reverse opioid overdoses.

Since 2023, naloxone has been available over the counter, although the out-of-pocket cost is generally lower when covered by insurance. The opioid crisis remains a pressing public health issue, with approximately 80,000 Americans succumbing to drug overdoses involving opioids in 2023.

Hu expressed hopes that the findings from this legal analysis will pave the way for future research examining the impact of prior authorization bans on insurer compliance and access to necessary medications for opioid use disorder. “With proper enforcement, patients in these states should face fewer delays and have an easier time obtaining the medications they need,” she stated. “Future research should assess how effectively these laws are functioning in practice and whether they are helping more individuals remain in treatment.”

This study serves as a significant contribution to the understanding of legislative actions surrounding opioid treatment and may influence future policy decisions aimed at mitigating the effects of the opioid crisis.