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New York Advocates Win One, Lose Another on Prior Authorization

January 08, 2020

The action was months in the making, and New York Gov. Andrew Cuomo's decision to sign one but not a second piece of legislation barring prior authorization for medications approved to treat opioid use disorder (OUD) has left state lawmakers and substance use treatment advocates with the proverbial half a loaf.

Speaking to now signed legislation he co-sponsored to prohibit prior authorization requirements for initial and renewal prescriptions for buprenorphine and naltrexone under private insurance (S. 4808/A. 2904), State Sen. Pete Harckham said today, “The current crisis of opioid use disorder will need to be addressed through a number of different initiatives, and doing away with prior authorization for medication-assisted treatment is a big step forward.”

However, Cuomo also elected to veto legislation sponsored by Harckham (S. 5935/A. 7246) that would have prohibited prior authorization requirements under Medicaid for any of the three federally approved medication treatments for OUD (methadone, buprenorphine and naltrexone). That led to a statement of concern this month from the state's Coalition of Medication Assisted Treatment Providers and Advocates (COMPA).

“What we are left with now is a disparity between the access people on commercial insurance may receive; versus the access those New Yorkers on Medicaid may receive,” said COMPA President Allegra Schorr. “We hope to address this in the legislative session ahead.”

Harckham hinted in his news release today that additional legislative action to combat the opioid crisis could be in the works this year. He said a forthcoming report from the Joint Senate Task Force on Opioids, Addiction and Overdose Prevention will include new legislative proposals.

Harckham is co-sponsoring legislation this year that would prohibit patient copayments for treatment received in an opioid treatment program (OTP).

It is believed that the issue of potential cost impacts led to the long delay in final action on the prior authorization bills by the Cuomo administration. Cuomo's veto of the bill pertaining to Medicaid comes despite the conclusions of a report commissioned by the Legal Action Center, finding that ending the often multiple-day treatment delays caused by imposing prior authorization would save the state substantial public health care dollars.

The report from RTI International used data from New York and other states to estimate that a state Medicaid formulary without prior authorization would decrease inpatient hospital admissions by 22% and emergency department visits by a staggering 104%. This could save New York $52 million in public dollars over a one-year period, the report suggested.

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