Part D Prior Auth for Opoid Treatment Drugs Is Disappearing

Just 3% have prior authorization rules for Suboxone and Zubsolv after CMS policy change; private plans and Medicaid may follow

Prior authorization requirements for buprenorphine-naloxone products has virtually disappeared from Medicare Part D plans after FDA label changes and last year's CMS announcement that it would not approved Part D formularies that required prior authorization more frequently than once a year.

The buprenorphine-naloxone combination is used to treat opioid addiction. As we reported two years ago, Insurers and their prior authorization policies have been criticized for causing potentially harmful delays in treatment.

The proportion of Part D plans that required prior authorization for brand-name buprenorphine-naloxone (Suboxone and Zubsolv) has plummeted from 88% for 2017 to 3%  for 2019, according to a research letter published in this week's JAMA

More Part D plans are also covering generic buprenorphine-naloxone, and the proportion requiring prior authorization went from virtually  all (96%) in 2017 to virtually none (.09%) for 2019, according to Tami Mark and her colleagues at RTI International. 

The data only pertains to Part D plans, but as Mark and her colleagues notes, Medicare often sets the standard for private plans and Medicaid.