In 2017 the Camden Coalition of Healthcare Providers began a pilot in partnership with local addiction treatment providers and UnitedHealthCare to see if removing prior authorization requirements for buprenorphine would reduce barriers to treatment and improve patient and system outcomes. The partnership arranged for UnitedHealthCare to waive prior authorization for the medication while still providing information about patient experience and health care utilization through data reports from the local health information exchange and meetings with clinical staff. During the 8 month pilot period, they demonstrated that treatment for opioid use disorder (OUD) with buprenorphine resulted in costs avoided, health care providers adhered to evidence-based practices for treating OUD, and the administrative burden on providers and patients was greatly reduced by eliminating prior authorization requirements. Camden Coalition and its partners used the findings from this pilot study to advocate for policy change in New Jersey and were successful in eliminating prior authorization requirements for medication assisted treatment in New Jersey Medicaid.
Funding Source: Camden Coalition of Healthcare Providers, Cooper Addiction Medicine, Project HOPE, UnitedHealthcare
Translating Local Innovation Into Statewide Policy: Lessons From a Medications for Addiction Treatment (MAT) Prior Authorization Pilot in Camden, New Jersey
A report on a pilot project in New Jersey that removed prior authorization requirements for buprenorphine and led to policy changes in New Jersey Medicaid.