Overcoming red tape to address the opioid crisis

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The opioid crisis is driving government, healthcare providers, and health insurance companies to find new solutions and pathways for faster treatment. For example, in March, Pennsylvania Governor Tom Wolf waived prior authorization for buprenorphine, a medication-assisted treatment for opioid addiction often known by the brand name Suboxone. New Jersey Governor Chris Christie also waived prior authorization for buprenorphine, but his policy did not apply to people on Medicaid. The good news is that, as we wait for states to implement legislative or administrative solutions to this critical issue, we are piloting innovative solutions to improve access for patients.

In South Jersey, a joint initiative of the Addiction Medicine Program at Cooper Hospital; Project H.O.P.E., a federally qualified health clinic; a leading health insurance company; and the Camden Coalition of Healthcare Providers has activated a pilot program that issues a “gold card” for our partners to skip the prior authorization process and expedite our patients’ access to buprenorphine.

Prior authorization is an administrative process insurance companies require of doctors before they may prescribe buprenorphine. Waiving prior authorization means that doctors can prescribe this often life-saving medication without submitting paperwork and seeking permission.

Buprenorphine helps patients fight opioid addiction by reducing withdrawal symptoms. Unlike other prescription drugs to treat opioid addiction, buprenorphine requires neither a daily trip to a clinic, nor a full detox in order to initiate. Quicker access to treatments like buprenorphine can translate into saved lives.

Why is prior authorization a problem? Prior authorization can delay access to treatment by over a week. During this delay, individuals motivated enough to connect with outpatient treatment — sometimes after a catalytic moment such as an overdose, discharge from jail, or following a medical complication from injection drug use — are forced to wait for a medication that prevents the symptoms of withdrawal and enables relief from addiction. This is exactly the wrong time to postpone treatment.

Together with experts like Dr. Lynda Bascelli at Project H.O.P.E. and Dr. Kaitlan Baston at Cooper Addiction Medicine, we have helped patients with complex health and social needs recover from opioid addiction through multiple programs. Dr. Baston referred Christine to our Camden Delivers pilot for women fighting addiction while pregnant, and we were able to help her secure housing and support. Working with Dr. Bascelli, our care management team is helping Charlie get back on track after a life on and off heroin and in and out of jail. Charlie and Christine are both doing well today and following their care plans with the help of medication-assisted treatment. Christine’s one-year old son is walking and learning to talk.

The vision for the Suboxone Gold Card program is that the disciplined teamwork between the insurance company and the providers on the ground will lead to a scalable, replicable program that allows the insurer to waive the prior authorization for any buprenorphine prescriber who meets a one-time set of criteria. Of course, a gold card program alone will not fix the opioid crisis. Truly addressing the problem will take much more than that. However, finding new ways for healthcare providers and health insurance companies to work alongside — and not against — each other will be an important part of the solution.

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