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Removing Prior Authorization Requirements For All Addiction Medication Will Save Lives And Reduce Healthcare Costs to New York

Clinicians, Family Members and Advocates Urge Governor Cuomo to Immediately Sign A.7246/S.5935 and A.2904/S.4808 into Law


New York, NY – December 6, 2019 – As the opioid-related overdose epidemic continues to devastate families and communities nationwide, a new study highlights the impact that removing prior authorization (PA) for opioid use disorder (OUD) medications would have in combatting this public health crisis. The data shows that removing prior authorization will decrease mortality and overall health costs.

Using New York State Medicaid data and research literature, the study Economic and Health Effects of Removing Prior Authorization from Medications to Treat Opioid Use Disorders under New York State Medicaid models the estimated reductions in opioid-related healthcare costs and mortality that would be realized if prior authorization requirements were removed from all medications to treat OUD in New York State Medicaid plans.

The study by RTI International finds that removal of prior authorization requirements on medications to treat OUD would increase utilization of these medications, leading to reductions in other health costs related to untreated addiction, including emergency room and inpatient care. New York would save Medicaid dollars by removing prior authorization requirements on medications to treat OUD.

More importantly, the study shows that the removal of prior authorization requirements in New York will save thousands of lives. Extensive research has shown that medication for OUD can cut a person’s risk of death in half. Increasing access to these medications will immediately result in fewer lives lost to opioid related deaths.

Legal Action Center and many other advocates continue to urge New York Governor Cuomo to sign legislation to remove prior authorization for all OUD medications in both commercial insurance and Medicaid in the state. Likewise, the American Medical Association has recommended that all states remove PA for medications to treat OUD. Arkansas, New Jersey, Illinois, Maryland, and Washington D.C. have all already heeded this call, recognizing the enormous savings in both lives and money from eliminating this barrier to proven treatment.

New York State cannot ignore the clear benefit of eliminating PA restrictions in terms of lives saved, population health benefits and overall healthcare savings.

“Decades of research show overwhelming evidence that medication for opioid use disorder, when provided promptly, can save lives. Studies, including this latest report, also show that requiring prior authorization can reduce the provision of OUD medication and limit access for patients who need it most. This study gives clear and compelling evidence that removing prior authorization requirements for OUD medications will significantly increase utilization, which will result in fewer opioid related overdose deaths and also decrease utilization of other expensive healthcare services” says Tracie Gardner, VP for Policy Advocacy at Legal Action Center.

“Amidst an unprecedented epidemic of opioid and other drug addiction, it is imperative that we increase access to evidence-based treatment that gives people the opportunity to get and stay well. Enactment of A.7246/S.5935 and A.2904/S.4808 to remove prior authorization for all medications to treat opioid use disorder will further solidify the state as a leader in combatting the crisis and demonstrate its commitment to saving lives,” states Christine Khaikin, Health Policy Attorney at Legal Action Center.

“Since losing my son Carter to opioid use disorder, I have dedicated myself to advocating for others affected by this disease. No person should have to suffer as my son did, and no family should have to go through such heartbreak. It astounds me that in order to receive medication to treat addiction one needs prior authorization. At the lowest time in someone’s life, a time when they are desperately seeking help and care, every second matters. Having to obtain prior authorization pointlessly wastes that precious time and can even dissuade people from seeking treatment at all,” shares Elizabeth S. Berardi, a committed advocate who tragically lost her son to OUD.

“The sooner Governor Cuomo signs legislation to remove prior authorization, the sooner more lives will be saved. New York State is in the midst of a devastating overdose crisis, and communities across the state should not have to wait another moment to access the lifesaving treatment they deserve,” adds Jasmine Budnella, Drug Policy Coordinator at VOCAL-NY.

“As New York State grapples with a sizable budget deficit caused, in part, by unnecessary hospitalizations, evidence from this study suggests that if the Governor signs this bill, New York State could reduce its deficit and save lives,” said John Coppola, Executive Director of the New York Association of Addiction Services and Professionals (ASAP).


RTI-study-on-PA-removal-in-NY-120419-1.pdf (159 downloads )

“For patients struggling with opioid use disorder, treatment with medications is the standard of care, and timely access to these medications is a matter of life and death. Prior authorization does nothing to improve the quality of care, but most certainly delays access to treatment and contributes to the epidemic of overdose deaths. It is time to remove this unnecessary and discriminatory hurdle that only serves to delay and discourage people from life-saving

treatment.” Asserts Dr. Tiffany Lu, Medical Director at Montefiore Buprenorphine Treatment Network.

“Governor Cuomo’s signature on these bills will undoubtedly increase access to treatment and reduce barriers for delivering crucial addiction services. Every day in New York people are dying from opioid overdose – in order to finally reverse the growing trend of opioid addiction and death, the state must continue to expand critical access to care, and removing the barrier of prior authorization is an integral part of that expansion, clearly evidenced by the latest data.” Said Allegra Schorr, President of The Coalition of Medication-Assisted Treatment Providers and Advocates of New York State (COMPA).


About Legal Action Center

Established in 1973, the Legal Action Center is the only non-profit law and policy organization in the United States whose sole mission is to fight discrimination against people with histories of addiction, HIV/AIDS, or criminal records, and to advocate for sound public policies in these areas. For more information, visit