I'm an addiction doctor, and I can't get lifesaving meds for many of my patients

Yahoo

20-02-2025

Opioid overdoses kill more than three Arizonans every day.
Luckily, we have an effective treatment: buprenorphine and methadone, collectively referred to as medications for opioid use disorder (MOUD). Not only do they treat the bone-crushing symptoms of opioid withdrawal, but they also keep people in addiction treatment and, most importantly, alive.
Public health experts consider these medications to be the gold standard treatment for opioid use disorder.
Unfortunately, it's easier to get the poison than the cure.
Whereas cheap fentanyl can be found on the streets, it is not so easy to access MOUD. Few physicians prescribe these life-saving medications, and much of rural Arizona does not have access to a methadone clinic.
And for the doctors who do prescribe MOUD, many are constrained by insurance companies' requirements for prior authorizations.
If a medication requires prior authorization, a doctor must first submit a form for the insurance companies to approve — essentially arguing why they are recommending a particular treatment for their patient.
If approved, the insurer will cover the bill. If not, the patient is on the hook, even if their doctor is adamant about the care they prescribed.
Although prior authorizations claim to save money for the health system and protect resources, they can actually increase overall costs by delaying access to necessary care, contributing to preventable hospitalizations and wasting health care providers' time — something that could be better spent seeing patients.
On average, physicians and their staff spend 12 hours a week fighting the red tape of prior authorization denials, according to a recent American Medical Association survey.
Perhaps it is no surprise that only 4.1% of overdose survivors receive MOUD, with an average 72-day delay. But for those who do, the results are stark: they are at least 52% less likely to die from a subsequent overdose.
Recognizing the challenges of prior authorization, the American Medical Association recommends that all prior-authorizations for buprenorphine be removed. Similarly, the American Society of Addiction Medicine recommends that payers 'eliminate prior authorization requirements for all formulations of addiction medications.'
As an addiction physician at the University of Arizona, I have cared for many patients who need a long-acting, injectable form of buprenorphine. Instead of having pills that they forget to take or that get stolen, they could just come to the clinic once a month for an injection.
But because of prior authorization requirements around this FDA-approved formulation, many of my patients cannot access the medication they need.
Inevitably, I get a call — they are back in the hospital.
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They couldn't afford their prescription. They relapsed onto fentanyl. And then they got sick again, whether it be from a recurrence of their soft tissue infection or an exacerbation of their heart failure.
This costly readmission could have been prevented if I could only have been allowed to treat my patient according to my own medical judgment.
To fix this problem, Arizona lawmakers have introduced House Bill 2674 to ensure that prior authorization requirements within the state's Medicaid program do not limit doctors from prescribing life-saving medications to those who need them.
While opponents may point to the potential cost of implementing this policy, there is significant funding available to support this mandate; Arizona has almost $500 million of opioid settlement funds remaining.
Furthermore, this bill will not open a floodgate of prescribers. Across the country, similar regulatory changes designed to remove treatment barriers have not significantly affected the amount of MOUD prescribed. Considering how few addiction specialists there are, few clinicians even know how to start these medications.
But for the clinicians who are willing, let's remove the regulatory obstacles in their path. By treating addiction like the chronic disease it is, HB 2674 offers a unique opportunity to combat the opioid epidemic and make life better for all Arizonans.
Dr. Melody Glenn is an addiction and emergency physician at The University of Arizona. Her first book, 'Mother of Methadone,' is forthcoming from Beacon Press this July. Reach her at [e-mail].
This article originally appeared on Arizona Republic: Fentanyl is easy to find. Addiction medications? Not so much | Opinion