Aetna Loosens Restrictions on Addiction Treatment Coverage

And now a bit of good news for addicts and their families who are concerned about treatment access in this uncertain healthcare climate. Leading health insurance provider Aetna recently announced plans to remove what has been critical roadblock for those seeking coverage for medication-assisted treatment for opioid addiction. The change will be implemented starting in March and will apply to all Aetna’s private insurance plans. Aetna, who is one of the world’s largest health insurance companies, is the latest provider to announce such plants over the past few months. Anthem and Cigna also announced looser restrictions on MAT with more and more Americans succumbing to overdose.

Specifically, Aetna will remove the requirement that doctors seek approval before prescribing medications, such as the buprenorphine-based Suboxone, to eligible candidates. Opponents of this requirement, called “prior authorization”, argue that it creates unnecessary delays in access to a potentially life-saving recovery resource. Mounting pressure, including findings from an investigation from New York’s Attorney General regarding coverage rates for addicts, compelled Cigna and Anthem to take this significant step. Aetna is the latest company to follow suit. With Medicaid expansions that make addiction and mental treatment more accessible facing uncertain futures in all states, it’s unclear what lasting impact this move will have or how many other insurance providers will follow.

In 2015, the United States saw record opioid overdose rates, eclipsing the all-time high of the prior year. Doctors at the ground level of this issue have expressed considerable frustration with the barriers that patients face when they’re ready to enter treatment. Addiction is a time-sensitive issue, and it’s rare that patients take the initiative to seek treatment on their own; when they do, it’s important that they have a clear and expedited path to treatment. Doctors have relayed powerful anecdotal evidence that if a patient is forced to wait for treatment, even for a few hours, there’s a chance they’re not coming back. Being forced to wait can permanently discourage them from seeking help.

Medications like Suboxone and Vivitrol have become a game-changing resource for eligible patients struggling with opioid and alcohol addiction. Looser restrictions on their dispensation from insurance providers represent one step forward in striking a balance between responsible prescription practices and proactive solutions for long-term treatment. With the epidemic of prescription opioid and heroin addiction claiming more and more Americans each year, it’s critical that vulnerable patients have every resource possible when endeavoring to overcome their dependency.

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