Kentuckians with substance use disorder can’t afford to wait for treatment
The sweeping coronavirus pandemic is forcing patients and providers to confront a difficult new reality—one in which social distancing is the norm and our healthcare system is being pushed to its limits. With the COVID-19 crisis requiring an all-hands-on deck approach, much attention is rightfully being paid to this emergency. Yet during this challenging time, we must be careful to continue addressing another ongoing epidemic: the opioid overdose epidemic. While the response to coronavirus is rightfully assertive, our state must ensure that people living with substance use disorder (SUD) can continue accessing the addiction treatment they need.
As one of the hardest hit states, virtually no corner of Kentucky has been left untouched by addiction. According to the latest data from the Centers for Disease Control and Prevention (CDC), Kentucky suffered the 5th highest rate of death due to drug overdose in 2017 at 37.2 per 100,000 residents. Opioids, including heroin and fentanyl, were the main culprits, taking the lives of 1,160 Kentuckians in 2017.
As an addiction treatment specialist in Independence, I see the toll that the ongoing opioid crisis is taking on our state every day. It breaks my heart to see parents burying children, children growing up without parents, and a growing list of people who succumbed to the complex, chronic brain disease that is addiction.
Unfortunately, too many Kentuckians will never get to enjoy the recovery they deserve simply because their insurance companies made them wait to get treatment.
Yes, even though you have health insurance, you may still have to wait for treatment. It’s called prior authorization, and when it interferes with the ability of an individual with SUD to access treatment, it’s unconscionable. Time is often of the essence in treating addiction and this unnecessary barrier works against my ability to save lives.
Prior authorization is referred to as a “utilization management” tool used by many insurers to control costs by making patients wait to receive insurance company approval before they can fill their prescription or receive other needed services. Oftentimes, my office must fill out additional paperwork and spend hours each week arguing with insurance company representatives—time that I would much rather dedicate to my patients.
This practice is not only frustrating and time-consuming for clinicians, it’s painful and can be deadly for patients. For people living with addiction, including opioid use disorder (OUD), we must provide treatment on the spot when they are ready. There is no, “Come back tomorrow.” Yet, the American Medical Association recently released a survey that found that 91% of physicians reported care delays due to prior authorization, with 65% reporting a delay of at least one business day.
A delay of even one day can literally mean the difference between life or death—I’ve seen it happen. Deterred by prior authorization delays, would-be patients often use opioids to stave off the painful symptoms of withdrawal, only to suffer a deadly overdose.
That is why I am wholeheartedly in favor of passing HB 389. The bill, currently under consideration by the Kentucky House of Representatives, is designed to ban insurers – including commercial insurance companies, the Department of Medicaid Services, and the state’s managed care organizations - from requiring prior authorization for prescription medications that are used in the treatment of alcohol use disorder and opioid use disorder.
No insurer should ever prevent patients from accessing high-quality, evidence-based, and comprehensive addiction treatment services. I urge our legislators to quickly pass HB389 so we can save more lives. Even in the midst of a worldwide health crisis, we have the power to address another crisis in our home state and ensure individuals with SUD get the help they need.
Michael Fletcher, MD is president of the Kentucky Society of Addiction Medicine.