Titan Pharmaceuticals Inc (TTNP)

[Doctor Detroit]

HHS is Finalizing Its Approach for Evaluating MAT Expansion Efforts but Lacks Performance Measures with Targets and Implementation Timeframes

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[b]Efforts by private health insurers. Officials from private health insurers reported that they are expanding access to MAT through outreach or training for providers and through the following three efforts:

• Eliminating the need for prior authorization to prescribe MAT medications. Officials from three insurers reported removing prior
authorization requirements for MAT medications, thereby making it
easier for patients to access needed MAT medications more readily,
rather than undergoing a waiting period for approval to receive the
medications. Other private health insurers told us that they continue to
require prior authorization, intended for safety reasons and to reduce
drug misuse, and officials from one insurer told us that they will allow
a patient to access a limited amount of MAT medications for a period
of 24 to 72 hours while making a determination about the appropriate
treatment services for the patient.

• Modifying health benefit coverage. Officials from one private health
insurance plan told us that the company is redesigning the benefit
coverage for methadone and has removed member copays. This
effort is intended to make MAT medications more affordable and allow
members who are not able to use buprenorphine to have an
alternative, such as methadone, that is not cost-prohibitive.

• Incentivizing providers and health insurance plan members to use
MAT. Officials from four private health insurance plans described
plans to offer incentives to providers or patients to use MAT. For
example, officials from three health plans stated that they are offering
alternative payment models or paying higher rates to providers that
offer MAT, and another private health insurer is offering incentives to
its members who are enrolled in behavioral health programs that
provide access to MAT.

http://www.gao.gov/assets/690/688047.pdf