Important Information re: prior authorization for MAT bills

March 5, 2020

Recently there has been a great deal of discussion and advocacy regarding the two Prior Authorization for MAT bills that were sent to the Governor’s desk earlier this year.  To date, only the bill that prohibits Prior Authorization for MAT for those with commercial health insurance was signed into law by the Governor.

That bill became effective last week.

This situation remains a significant problem that we are working to address here in Albany.  But in the meantime we wanted to make sure you have complete and accurate information as you continue to address the MAT needs of your clients.

We are grateful to Rob Kent at OASAS for quickly providing this information to us based on our request.  If you have questions, please do not hesitate to contact the NYS Council at your convenience.

1) FFS Medicaid and every MMC plan has a formulary that must include all types of MAT (i.e. a version or versions of bupe, methadone and long-acting injectable naloxone.

2) The Medicaid MAT bill is about buprenorphine as methadone is protected already as is Vivitrol (injectable natrexone).  Methadone for treatment of OUD can only be administered and dispensed by state and federally certified Opioid Treatment Programs and these programs are protected by law and MMC contract from prior authorization.  Vivitrol is protected by the 2016 law which eliminated PA.

3) None of the various formulations of buprenorphine are therapeutically superior to any of the others.

4) Some of the bupe makers are offering a fair and reasonable price and are already protected by current law from prior authorization as they are included in the formulary.

5)  There is an exceptions process where a patient can be maintained on a non-formulary version of bupe when clinically indicated (i.e. patient is stable on that version) and there is an expedited process to approve exceptions (within 24 hours).

6) There is immediate access to a 5-day supply of non-formulary versions of bupe in both FFS and MMC while the prescriber is seeking an exception to the formulary.

7) The Governor has proposed in his budget to create a single statewide MAT formulary for FFS and MMC to create consistency.  His proposal also offers the opportunity for all bupe makers to offer a fair and reasonable price to enable them to be placed in the formulary.