Lawmakers in the state Senate are expected to vote on a bill next week that would cut down on administrative delays for Vermonters seeking treatment for opiate addiction.
The proposed legislation would force insurance companies to automatically cover drugs used in medication-assisted treatment (MAT) without requiring doctors to get prior authorization from the insurer.
Advocates and physicians supporting the legislation say patients can struggle while awaiting that approval.
“It can be two days before that would be authorized,” said Dr. Kathleen McGraw, the chief medical officer at Brattleboro Memorial Hospital. “When somebody’s coming in and saying, ‘I’m ready for help,’ in two days they will be going through dramatic withdrawals.”
Those withdrawals can drive even the most well-intentioned people to the illicit drug market for relief, McGraw said.
McGraw called prior authorizations a “harmful hoop” that patients and doctors are forced to jump through. According to Blue Cross and Blue Shield of Vermont’s website, prior authorizations prevent costly and ineffective treatments.
“We provide benefits for certain services, drugs and supplies only if approval is obtained in advance,” the site reads. “This ensures the procedures are diagnostically appropriate, medically necessary and cost effective.”
The legislation initially raised concerns for BCBSVT as well as MVP Health Care, but both companies support compromise language that the Senate Health and Welfare Committee passed unanimously on Thursday morning.
Lobbyists for both companies told the committee that the insurers don't require prior authorization for opiate treatment drugs, so it wasn’t a problem to put the policy into law.
The bill, S.43, would ban prior authorization for MAT drugs that are prescribed in accordance with U.S. Food and Drug Administration guidelines. To keep the drugs affordable, it would also require insurers to offer one type of each class of MAT drug — buprenorphine, methadone and naltrexone — at the cheapest possible rate for patients.
McGraw said the legislation will allow doctors to act quickly to help Vermonters trying to address active opiate addiction.
“If somebody is ready for treatment, the time to start that treatment is now,” she said.
Health and Welfare Committee chair Ginny Lyons (D-Chittenden) said she doesn’t expect the bill to go through any other committees before the full Senate votes on it. That vote is expected next week.