When Casey was finally ready for treatment, the insurance company created more delays

Insurance prior authorization requirements delay care when a patient is willing to get treatment.

By Michelle Schwartzmier

We were struggling to find a bed in rehab. Insurance got in the way, so we found a lot of obstacles there, unfortunately. It’s very frustrating to me because when an addict wants help, there should be no barriers ever. So she was continually keeping herself afloat, treading water while she was waiting for rehab and packing. We had settled on a rehab facility, and she was really excited about going and starting this new life, but unfortunately, she overdosed the night before. Literally sitting next to her packed suitcase.

Michelle’s story is taken from a video transcript and has been edited for clarity.

The Problem

Health plans commonly require a patient’s provider to obtain approval from the health plan before a patient receives a heath care benefit; a practice known as prior authorization. Prior authorization imposes a unique barrier on individuals with substance use disorder (SUD). Engaging and retaining patients in SUD treatment can be difficult because addiction affects the parts of the brain responsible for motivation and decision-making, creating narrow and shifting windows in which a patient is motivated to engage in treatment. Requesting and obtaining prior authorization can impose delays in the initiation of care, which can lead to serious consequences for the patient, including failing to return for subsequent appointments, resuming substance use, medical complications, overdose and death.

The Solution

Prohibit health insurers from imposing prior authorization requirements on substance use disorder benefits.

Take Action

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Prohibit the use of prior authorization for medications for opioid use disorder in Medicaid

Tell your members of Congress that you support prohibiting the use of prior authorization for medications for opioid use disorder in Medicaid and ask them to co-sponsor the Comprehensive Addiction and Recovery Act (CARA 3.0).