Agreement to Limit Substance Abuse Treatment Prior Authorization Announced

January 23, 2020

State Assembly Rep John Nygren (R-Marinette) announced at a State Capitol press conference Jan. 21 that several health insurers in Wisconsin have agreed to remove various prior authorization requirements for substance abuse treatment. 
“WHA is pleased to see health plans removing prior authorization requirements that have placed barriers on individuals seeking substance abuse treatment and added unnecessary administrative burdens to physicians and health care professionals providing substance abuse services,” WHA President and CEO Eric Borgerding said in a statement following the press conference. “We thank Rep. Nygren for his continued dedication in fighting for patients who need addiction treatment.”
“We were able to accomplish this, most proudly, without legislation; this is due to the conversations and relationships that have been developed over a multi-year effort here in Wisconsin,” Rep. Nygren said. “Rather than having government tell people how to perform their business, having a one-on-one conversation about what is best to serve Wisconsin, I believe, is the best direction forward for us.”
Cynthia Valentin, Ph.D., Advocate Aurora behavioral health vice president of therapy services, told the press that removing prior authorization requirements would allow physicians and other health care professionals to “focus on treatment and not spend hours on paperwork.” She noted that practitioners and their patients have faced delays in treatment of hours to weeks due to prior authorization requirements. Removing prior authorization requirements will remove treatment barriers that have discouraged individuals “on the road to recovery,” Dr. Valentin said.
Representatives from UnitedHealthcare, Anthem, WPS Health Solutions, Children’s Community Health Plan, Network Health, Quartz, Dean Health Plan, Security Health Plan and MercyCare Health Plans joined Rep. Nygren at the announcement. Several of the health plans indicated they had already removed prior authorization requirements for substance abuse treatment prior to the announced agreement.
“The major insurers in Wisconsin, many of our larger regional health plans in Wisconsin, are here,” Rep. Nygren said. “I believe it’s going to set an example for the others to follow and that will impact everyone long term.”
“Wisconsin has been a recognized national leader in efforts to combat opioid and substance abuse,” Dr. Valentin said. “Today’s announcement is a prime example of our state’s leadership to continue this recovery.”

This story originally appeared in the January 23, 2020 edition of WHA Newsletter