Starting this week, Medicaid recipients in New Jersey no longer have to wait for approval from an insurance company before a doctor can prescribe them opioid-addiction medication.
The state’s Human Services commissioner announced that New Jersey is ending so-called prior authorizations for medication-assisted treatments (MAT), which research shows gives patients a better shot at lasting recovery.
Previously, people interested in MAT had to wait, sometimes for days, as doctors submitted the required paperwork and received the go-ahead from a patient’s Medicaid managed-care plan. Prior authorizations are generally pitched as a cost-saving measure for insurers to determine whether a patient requires the treatment — or if there are cheaper effective treatments available.
But for people with an opioid-use disorder, such delays can be deadly. The pain of withdrawal — especially from powerful synthetic opioids like fentanyl, which has contaminated most of the region’s illicit drug supply — is enough to send a person with addiction back to the street, where they risk overdose and death.
“Over and over again, we had heard from frontline providers that they had gotten someone to a point where they were ready to go on MAT,” said Roseanne Scotti, the New Jersey state director of the activist group Drug Policy Alliance.
“And then it was like, ‘Well, call us back in 48 hours,' while they would wait to get this treatment approved. By then, individuals could have overdosed, or lost that will they had gotten to go to the doctors — and been lost again to the street.”
More than 3,000 people died of drug overdoses in New Jersey last year, up from 2,685 in 2017.
Scotti said she was “thrilled” with the state’s decision to waive MAT authorizations for Medicaid recipients, and added that a bill is moving through the state legislature to make the change permanent. A law requiring private insurers in New Jersey to waive prior authorizations for MAT is already on the books.
The bill is one of several that New Jersey lawmakers are considering to battle opioid addiction; in October a state assemblywoman proposed a bill that would launch a pilot program to open a supervised injection site where people could bring their drugs and use them in the presence of medical staff who could revive them if they overdose. Another bill would require warning labels on bottles of opioid pain pills.
Pennsylvania has already waived prior authorization rules, but its lawmakers have not proposed bills on supervised injection sites.
But prior authorization isn’t the only barrier to MAT. Stigma, especially the misleading notion that MAT is simply replacing one drug for another, keeps many from seeking the treatment at all. In Philadelphia, city officials recently launched a campaign to fill about 3,000 empty MAT slots.
Even though Pennsylvania waived prior authorizations for Medicaid recipients last year, and worked with the state’s major private insurers to do the same, just 3 percent of doctors statewide are authorized to prescribe buprenorphine, an opioid-based medication that is one of the three most common MATs. Only about 1,200 doctors in New Jersey are licensed to prescribe the drug, according to federal data.
Carole Johnson, New Jersey’s Human Services commissioner, said the state was working to encourage more doctors — especially primary-care physicians — to get certified to prescribe buprenorphine.
The state is improving Medicaid reimbursements for doctors who take on patients with addiction, and paying for “navigators” at primary-care practices to help people with addiction access social services that can help stabilize them in recovery.
“We’re really also thinking about the social determinants of health as they relate to helping people sustain recovery,” Johnson said. “We can make all these investments in treatment, but unless people who are in treatment see a path to employment and housing, their recovery is more vulnerable.”