Key finding: The majority of surveyed managed care organization (MCO) pharmacy directors and medical directors (PDs/MDs) reported their MCOs have taken or plan to take ICER’s four proposed action items to improve patient access opioid addiction treatments in light of the ongoing opioid addiction crisis.

Of the proposed actions, the greatest percentage of surveyed MCOs (82%) have, or plan to, streamline the prior authorization (PA) process for prescribers who are deemed “reliable;” some insurers have gone so far as to entirely remove the PA requirement for privately insured patients seeking opioid addiction treatment.

Easing counseling requirements and exempting successful patients from certain criteria are two actions taken by nearly 40% of surveyed MCOs and that would lessen the treatment burden on the healthcare system by reducing the use of resources, but also decreasing the burden to patients who may not have easy access or time to attend psychosocial therapy or fulfill the monitoring requirements.


The “so what” for decision makers: The fight against the opioid epidemic is two-fold, strategies must be explored to limit patient access to opioids and policy changes need to be made to expand the treatment for opioid addiction.

Surveyed physicians indicated PA restrictions as one of the most onerous market access hurdles they encounter when prescribing opioid addiction therapies; payer actions to streamline this process and lessen the burden would be a welcome change to prescribers.

In addition to easing the physician burden of prescribing opioid addiction treatments, these action items would decrease the time it takes for a patient to receive their medication, which is critical to preventing relapse and lessens the possibility of a patient changing his or her mind about starting treatment.


What else are payers saying about opioid addiction access and reimbursement?

The full Opioid Addiction | Access & Reimbursement | United States report answers:

  • What is the current reimbursement landscape of key branded and generic opioid addiction therapies?
  • What are the reasons that some branded agents (e.g., Indivior’s Suboxone Film) have preferred status over other brands (e.g., BioDelivery Sciences’ Bunavail)?
  • Which market access factors are most influential in a physician’s choice of opioid addiction treatment?
  • What measures, if any, have payers taken to improve patient access to opioid addiction therapies?
  • What access and reimbursement challenges will emerging buprenorphine depot therapies face?


Markets covered: United States.

Methodology: Surveyed 102 psychiatrists in the United States and 34 U.S. managed care organization (MCO) pharmacy and medical directors (PDs/MDs).

Key drugs covered: Sublocade, CAM-2038, Suboxone Film, Zubsolv, Bunavail, Probuphine, Vivitrol, Subutex, Methadose

Key companies mentioned: Alkermes, BioDelivery Sciences, Braeburn, Camurus, Covidien-Mallinckrodt, Indivior, Orexo


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