Madison–Today State Representative John Nygren (R-Marinette) announced a partnership with insurers, members of the recovery community, healthcare providers and other members of the legislature to expand access to medication-assisted treatment:
“Today, we are proud to announce that medication-assisted treatment (MAT) will be expanded across Wisconsin through the elimination of prior authorization requirements in most cases. This is one of the most impactful reforms we have accomplished as a part of the HOPE Agenda and we were able to accomplish it without passing legislation.”
Major health insurance companies already have or have now agreed to remove prior authorization requirements for most substance use disorder treatments. Prior authorization is the requirement that a doctor obtains approval from a health insurance plan before prescribing a treatment plan or prescription. This change will expand substance abuse treatment to over a million covered lives.
Under the agreement, major health insurers will cover at least one buprenorphine-naloxone product; methadone; injectable and oral forms of naltrexone, which blocks the effects of opioids; and at least one form of naloxone without pre-approval from the insurance company. Although benefits designs vary, insurers also will provide MAT coverage at the lowest patient cost tier on many of the plan’s drug lists. This will allow individuals suffering from substance abuse disorder to get MAT quicker and more affordably.
This is the second important patient access initiative championed by Representative Nygren in this session. Earlier this year, Representative Nygren shepherded a bill through the state legislature that reformed Wisconsin’s step-therapy protocols.
“This is a monumental change that will play a key role in ensuring individuals receive the necessary care to start their journey into recovery. Now healthcare providers can immediately begin a treatment plan in most cases, eliminating an obstacle to treatment for individuals impacted by addiction. This reform, paired with our package of bills that have been recently introduced, are critical components to improving access to treatment for Wisconsinites.”
“I would like to extend my sincere thank you to everyone gathered here today for their continued dedication and passion for combating substance abuse in Wisconsin. There is no doubt in my mind that today’s announcement will save lives.”