State Laws Banning Prior Authorization For Medications For Opioid Use Disorder Increased Substantially, 2015-23

Area of Science:

• Public Health Policy
• Substance Use Disorder Treatment
• Health Insurance Regulation

Background:

• Prior authorization (PA) acts as a significant barrier to accessing medications for opioid use disorder (MOUD).
• While private insurance covered a substantial portion of patients with opioid use disorder (OUD) in 2023, specific prohibitions on PA for MOUD within private insurance plans are not well-understood.
• Understanding state-level legislative actions is crucial for assessing access to MOUD.

Purpose of the Study:

• To synthesize and analyze state laws that prohibit prior authorization for MOUD within private insurance across the United States.
• To track the evolution and variations in the scope of these legislative prohibitions over time.

Main Methods:

• Systematic synthesis of state legislation prohibiting prior authorization for MOUD in private insurance.
• Categorization of prohibitions into 'full' (all MOUD) and 'partial' (conditional) based on legislative scope.
• Analysis of trends in the number of states enacting such laws and the types of prohibitions implemented from 2015 to 2023.

Main Results:

• The number of states with laws prohibiting prior authorization for MOUD in private insurance increased from two in 2015 to twenty-two in 2023.
• Seven states enacted full prohibitions covering all MOUD, while fifteen states implemented partial prohibitions with varying conditions and limitations.
• Over time, several states transitioned from partial to full prohibitions, and many broadened the scope of existing partial prohibitions.

Conclusions:

• The significant increase in state laws prohibiting prior authorization for MOUD demonstrates a clear legislative trend towards reducing access barriers.
• Variations in the scope of these prohibitions indicate ongoing policy development and differing state approaches to ensuring MOUD access.
• This legislative activity underscores prior authorization for MOUD as a key area of focus in state policy aimed at combating the opioid crisis.