Several health insurance companies in Wisconsin are taking steps to speed up access to treatment to combat substance use disorder under a new deal lawmakers and industry representatives announced Tuesday.
The agreement includes a number of companies that have already or are planning to remove the requirement that doctors seek prior authorization from insurers before prescribing treatment for certain services to curb addiction.
Backers — including Rep. John Nygren, who has become the Legislature’s torchbearer for combating the state’s heroin and opiate epidemic — say the effort will expand treatment, help end delays in getting prescriptions and save lives.
"This is a monumental change that will play a key role in ensuring individuals receive the necessary care to start their journey into long term recovery," the Marinette Republican said at a Capitol news conference.
Nine companies have agreed to end the prior authorization requirements for certain treatment: United Healthcare, Anthem, WPS Health Solutions, Children’s Community Health Plan, Network Health, Quartz, Dean Health Plan, Security Health Plan, and MercyCare Health Plans.
Aurora Behavioral Health vice president of therapy services Cynthia Valentin said the change would allow care providers to "focus on treatment and not our spend hours in paperwork."
She added practitioners would no longer have to wait between 72 hours and two weeks for prior authorization for certain treatments. That time delay, she noted, would often discourage patients who sought to "enter into the road for recovery."
"In those moments and in their pain, oftentimes the decision is immediately changed to returning to the drugs of choice because the pains of their addiction has overwhelmed that moment," she said.
The agreement to axe the requirements isn't a formal, signed document, Nygren told reporters. Rather, some companies are "stepping up and they're saying, 'Yes, we will make this change because we recognize how significant it is for people who need these treatments,'" he said.
In all, health insurers agreed to cover at least one product to treat addiction, such as naloxone, without prior authorization. Still, the practice would apply in some instances for substance use disorder treatment, Nygren said, such as in the case of a pregnancy.
Nygren said he didn't know which percentage of the insurance companies that do business in Wisconsin have agreed to the move. And he didn't say whether conversations with other groups to get on board are ongoing.
"The major insurers in Wisconsin, many of our larger regional health plans in Wisconsin, are here," he said. "I believe it’s going to set an example for the others to follow and that will impact everyone long term."
Tuesday morning's announcement comes hours before the state Assembly is poised to take up a slate of new HOPE agenda bills from Nygren aiming to combat the opioid epidemic in Wisconsin.