Posts Tagged ‘prior authorization for buprenorphine’

I’m Back

 

 

 

 

 

 

I’m back to blogging, after a short break, during which I took my Addiction Medicine board re-certification exam. I think I did well on it, but with those sorts of exam one never knows for sure. If any of my readers are planning to take the exam soon, I have a bit of advice: it’s great to go to the annual Review Course hosted by the American Society of Addiction Medicine, but you should also read the textbook, “Principles of Addiction Medicine.”

I listened to both the 2018 and 2019 Review Courses online. Those courses are great if you want to know all the essentials of the field. However, many of the questions on the test went a layer deeper than the review courses covered.

For example, rather than just asking which receptor type a drug of abuse activates, the test would ask what subtype of that receptor was involved. I don’t find that sort of question to be clinically relevant, but then I’m not a researcher, just a worker on the front lines of the opioid epidemic.

So now I’m happy to back into my routine, seeing patients and doing the work I love.

However, this month I’ve had to confront issues that I thought were resolved months ago. For example, I’m vexed by new prior authorization forms. It seems that large insurance companies like Cigna might be asking smaller companies to do their management of prescription costs, a service euphemistically called “pharmacy benefit management.”

This is an example of a form I got last week:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

As you can see, it asks for chart notes, drug screen results, documentation that the patient isn’t on any other opioids, per the state prescription monitoring program, and a plan and evaluation/assessment for potential to taper.

This happens to be a patient of mine who has been in successful, relapse-free recovery for over nine years. She is extremely high functioning at her job, and a delightful patient. I provided all the information they needed to approve her generic buprenorphine/naloxone medication, but I don’t think that should be required for coverage. They approved it for only six months, so we’ll have to repeat this process twice per year.

I think it’s discriminatory to demand this of a patient in treatment for opioid use disorder, but not for diabetes. It also discourages providers from wanting to treat patients with buprenorphine products, since it requires considerable time and energy to respond to these prior authorization demands.

Another company, called Southern Scripts, working for a larger health insurance company, asked for this form to be completed on a patient prior to paying for his buprenorphine/naloxone tablets:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

After completing the form and asking for an expedited review, I got this letter:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

There’s no way I’m sending notes regarding a patient’s substance use disorder treatment to an insurer, so instead I wrote a summary letter, in which I described the progress this patient has made & how well he is doing, and that delay in coverage for his medications could have catastrophic medical consequences to his health.

In response to my letter, Southern scripts issued a six-month approval for coverage of his medication. So, in six months, we’ll do this whole thing over again, I guess.

We are now twenty years into this opioid epidemic. I thought we were all at the point where we realized that it’s not good public policy to have insurance companies erect barriers to treatment with buprenorphine products to treat patients with opioid use disorder.

I’ve saved the best for last.

I’ve dealt with my share of frustrations with pharmacists and pharmacies.

Readers know I went to electronic prescribing a month or so ago. Last week one of my patients, stable for years, went to get his refill from his pharmacy. I submitted it electronically, and put one refill on it, since I see him only every two months at this point.

When the Walgreen’s pharmacy refused to give my patient his refill, he called my Health Services Manager, who called the pharmacy. They said my patient’s refill had been cancelled, and that I would need to submit a new electronic prescription. Worried I’d made an error, I went to my E-prescribing program and found I did write for a refill. Confused, I asked my Health Services Manager to call the pharmacy back, to discover why they wouldn’t honor the refill.

They told him that Schedule 3, 4, and 5 opioids could not be refilled, and that a new prescription had to be submitted.

This is not accurate, of course.

I wasn’t in a mood to argue. I just re-submitted the prescription and my patient filled it. Of course, now on my e-prescribing software it looks like I issued two prescriptions for the same month, which I did. I’ll have to document in his chart about the problem with the pharmacy.

I had hoped e-prescribing was going to remove some of the difficulties I’ve encountered with the pharmacies filling buprenorphine products. Now, I’ve lowered my expectations.