October 21, 2016

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Settlement With Major Global Health Insurer Will Remove Barriers To
Life-Saving Treatment For Opioid Use Disorder

Other Health Insurers Are Encouraged To Follow Cigna’s Policy Change

NEW YORK – Attorney General Eric T. Schneiderman today announced that
Cigna, a major global health insurer, will end its policy of requiring
prior authorization for medication-assisted treatment (“MAT”) for opioid
use disorder. Cigna’s change comes just months after Attorney General
Schneiderman requested that the company provide information about its MAT
policies to address concerns about barriers to treatment for opioid use
disorder. Preauthorization requirements can lead to delays – sometimes
significant — in patients obtaining treatment for addiction.

MAT, when prescribed and monitored properly, has proved effective in
helping patients recover from opioid use disorder, and is both safe and
cost-effective to reduce the risk of overdose. This policy change will
apply not only to most members in New York, but nationally as well.

Cigna required providers to submit a prior approval form for MAT requests,
which required the providers — who had already received specific training
regarding MAT in order to prescribe these drugs — to answer numerous
questions about the patient’s current treatment and medication history.
Authorization in some instances took several days.

“Removing barriers to proven effective life-saving treatment is an
important component to address New York’s and the nation’s opioid addiction
crisis. Getting people into treatment faster, and when the window of
opportunity is open, is vital to stemming the opioid addiction crisis. I
applaud Cigna for taking this action,” said *Attorney General Schneiderman*.
“Other health insurers should take notice of Cigna’s actions to remove
access barriers to treat opioid dependency and I encourage those insurers
to follow suit.”

“Pre-authorization requirements for addiction medications are harmful and
discriminatory,” said *Sally Friedman, Legal Director of the Legal Action
Center*. “The Legal Action Center welcomes Cigna’s discontinuation of this
practice for buprenorphine. This change, together with Cigna’s existing
policy of not requiring pre-authorization for methadone, naltrexone, and
other addiction medication, will save lives. Attorney General Schneiderman
deserves praise for his aggressive enforcement of laws promoting access to
treatment for substance use disorders. All insurers should remove barriers
to coverage for FDA-approved medications to treat addiction.”

“ASAM applauds Attorney General Schneiderman’s agreement with Cigna to
discontinue the requirement of prior authorization requirements for
coverage of buprenorphine containing medication. There is often a small
window of opportunity for a person seeking help to engage in treatment.
Waiting for days to obtain medication to treat this condition represents an
unnecessary risk for a deadly outcome. Hopefully, other payers will follow
Cigna’s lead in decreasing barriers to access to this lifesaving
medication,” said *Kelly Clark, President Elect, American Society of
Addiction Medicine*.

Unlike methadone treatment, which must be administered in a highly
structured clinic, MAT medications, usually containing buprenorphine and
naloxone, may be prescribed or dispensed in physicians’ offices to treat
opioid dependency, provided the treating physician has obtained the
appropriate certification and has been issued a special DEA license. In
addition to the medication component, psychosocial therapy and management
of medical issues are also recommended components of MAT to treat opioid

Buprenorphine is an opioid partial agonist, meaning that it has lesser
euphoric effects than full opioid agonists such as heroin. At low doses,
buprenorphine produces sufficient agonist effects to enable opioid-addicted
individuals to discontinue the misuse of opioids without experiencing
withdrawal symptoms. Buprenorphine carries a lower risk of abuse,
addiction, and side effects when compared with full opioid agonists.
Naloxone is an opioid antagonist that can be added to buprenorphine that
will decrease the likelihood of diversion and misuse of the combination
drug product. If the combination drug product is crushed and injected the
naloxone and can bring on opioid withdrawal, which serves as a deterrent to
diversion and misuse. According to the Centers for Disease Control (CDC),
the number of drug overdoses related to opioid abuses have increased
dramatically over the past decade, including over 2,000 drug overdose
deaths in New York and over 10,000 overdose deaths nationally in 2014.

The CDC considers MAT a proven, effective treatment for individuals with an
opioid use disorder. MAT has been shown to increase treatment retention and
to reduce opioid use. One research study showed that for half the patients
treated with buprenorphine/naloxone for addiction to opioid pain relievers,
they were abstinent from the drugs 18 months after starting MAT, and after
three and a half years 61% of the patients reported abstinence. MAT is
supported/endorsed by the CDC, the Substance Abuse and Mental Health
Services Administration (SAMHSA), the American Society of Addiction
Medicine (ASAM), the New York State Office of Alcoholism and Substance
Abuse Services (OASAS) and the New York City Department of Health and
Mental Hygiene (NYCDOHMH) as a treatment for opioid addiction.

Addressing access barriers to MAT is just the latest step that Attorney
General Eric T. Schneiderman has taken to address the opioid addiction
crisis. In June of 2011, Attorney General Schneiderman introduced state
legislation for I-STOP, an online Prescription Monitoring Program or a
“PMP,” that enables doctors and pharmacists to report and track controlled
narcotics in real time. I-STOP became effective in August of 2013, making
New York State one of the first states to establish such a PMP, and has
reduced “doctor-shopping” by 75%. The OAG has also aggressively enforced
laws that require parity in health plan coverage of mental health and
addiction treatment, reaching agreements with six companies, including
Cigna, MVP Healthcare, EmblemHealth, Excellus, Beacon Health Options, and
HealthNow. The Attorney General’s Office has prosecuted many health care
providers who illegally prescribed and diverted opioids. The OAG’s
Community Overdose Prevention (COP) Program, which equips New York law
enforcement agencies with a life-saving heroin overdose antidote, has saved
more than 100 lives. The OAG has also reached agreements with Purdue Pharma
and Endo Pharmaceuticals Inc., to ensure that these opioid makers engage in
responsible and legal marketing.

Cigna’s policy change follows efforts by both New York state and the
federal government to increase access to MAT for opioid dependency. New
York State recently enacted legislation prohibiting insurers from requiring
prior authorization for emergency supplies of MAT medications and also
removed prior authorization for Medicaid members seeking MAT for opioid
dependence, while the federal government increased the maximum number of
patients that MAT certified physicians can treat at one time from 100 to

“In recent years, we have lost too many of our loved ones to addiction
disorders. Many of these addictions started through self-medication of a
mental health issue. This horrific epidemic has to end, and one way of
doing so is to insure that people have full access to medication assisted
treatment disorders. The Mental Health Association in New York State, Inc.
(MHANYS) applauds Attorney General Eric Schneiderman for reaching an
agreement with CIGNA in regard to the elimination of prior approval for
these treatments,” said *Glenn Liebman, Chief Executive Officer of the
Mental Health Association of New York State*.

“The Long Island Council on Alcoholism and Drug Dependence (LICADD)
commends New York State Attorney General Eric Schneiderman for his
continued leadership in confronting insurance companies in New York State
to increase access and availability to evidence based treatments on demand
for individuals, and their families, contending with opiate dependence,”
said *Steve Chassman, LCSW, CASAC, Executive Director of LICADD*.
“Medication- assisted treatment (MAT), in conjunction with intensive
psycho-social treatment modalities, has been proven effective in providing
individuals with a pharmaceutical safety net needed as they move along the
continuum of change towards recovery from the debilitating illness of
opiate dependence.”

“Medication-assisted treatment (MAT) for opioid use disorder gives
individuals and families dealing with addiction options,” said *Avi Israel,
President and Founder of Save the Michaels of the World*. “For example, the
flexible nature of MAT may allow someone who is battling addiction to keep
a job while receiving treatment. I thank Attorney General Eric Schneiderman
for continuing to eliminate obstacles to treatment, and I join him in
urging other insurers to follow Cigna’s lead.”

Consumers with questions or concerns about this settlement or other health
care matters may call the Attorney General’s Health Care Bureau Helpline at

The investigation of this matter was conducted by Assistant Attorneys
General Brant Campbell and Michael D. Reisman, of the Attorney General’s
Health Care Bureau, which is led by Bureau Chief Lisa Landau. The Health
Care Bureau is a part of the Social Justice Division, led by Executive
Deputy Attorney General for Social Justice Alvin Bragg.

Read the agreement with Cigna


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