By Kevin Petersen
State Representative, 40th Assembly District
Your high school daughter – a star soccer player – awkwardly tumbles and breaks her arm. Your grandson playing college football injures his leg making a tackle. Or your neighbor had a surgical procedure. To overcome their injuries’ pain, an opioid based medication may have been prescribed. Opioid addiction normally isn’t sought, but it subtly overtakes the user’s life until their addiction becomes their drive.
I was honored to join Representative John Nygren’s press conference (R-Marinette) announcing a partnership with insurers, members of the recovery community, and healthcare providers to expand access to medication-assisted treatment (MAT).
By definition, medication-assisted treatment is the use of medications in combination with counseling and behavioral therapies for the treatment of substance use disorders. Without passing legislation, MAT will be expanded across Wisconsin through the elimination of prior authorization requirements.
Major health insurance companies already have or have now agreed to remove prior authorization 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 schedule or medication. This change will expand substance abuse treatment to approximately a million covered lives in Wisconsin.
In the press conference, Dr. Cynthia Valentin, Vice President of Aurora Behavioral Health Therapy Services indicated that practitioners had previously waited anywhere from 72 hours up to 30 days for a MAT pre-authorization. She stressed that because of those waiting periods, addicts seeking treatment too often relapse, frequently overdosing. This waiting period is now being removed.
Kevin Roy, Chief Public Policy Officer for Shatterproof – a national nonprofit organization dedicated to reversing the cycle of addiction – spoke about the results in one study which showed a 30% reduction of heroin related fatalities based on the access of MAT in other states.
Dr. Julie Mitchell, Regional Vice President and Senior Clinical Officer for Anthem added, “Every month about 75 Wisconsinites die because of opioid use.” She continued that approximately 3,500 Wisconsinites visited an emergency room or hospital in the past year because of an opioid use problem.
Under the MAT 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.
In addition to this announcement, since 2014 I have co-sponsored 30 bipartisan bills as part of the Heroin Opioid Prevention and Education (HOPE) agenda. The bills have expanded access to treatment, gathered information on prescribing practices, gone after drug traffickers, and ensured tools like the state’s Prescription Drug Monitoring Program are working.
Addiction of any kind has no district boundaries. This is just the next stage of addressing drug addiction in Wisconsin via the HOPE agenda. There’s still a lot more work to be done. I look forward to continuing the partnership with all of my colleagues in defeating substance abuse disorders in the 40th Assembly District and the state.