Date of Award
College of Nursing
Karen Burritt, PhD, RN, FNP-BC
Sandy Dettmann, M.D., DABAM, FASAM
Darlene Hoffert, DNP, RN, AGNP-C, QMHP, LNC
Introduction: Patients that require medication assisted treatment for opioid addiction can have their treatment delayed through the prior authorization process. A prior authorization is required by many insurance companies and can cause lengthy delays before the drug is approved. The two drugs that were considered for this project were Suboxone® (buprenorphine/naloxone) and Sublocade® (buprenorphine). These drugs are used for the treatment of opiate addiction. The proposed solution to the problem was to use quality improvement methods to implement a tracking and tickler system to improve the approval time from the insurance company.
Objectives: The project goal was to decrease the amount of time from the time the prescription was written until the medication assisted treatment was initiated.
Methods: This project used quality improvement methods to review pre and post intervention data. The setting is a single physician addiction medicine clinic.
Results: There were no changes in the amount of time between prescribing and start of treatment with the tickler and tracking system. When drugs are added to the insurance company’s formulary, prior authorizations are not required. Any improvement in the time from prescribing to medication start was related to changes in the insurance company’s formulary.
Conclusions: Tracking the prior authorizations did not change the time frame of which they were completed.
Implications: With the opioid epidemic, patients are dying daily across the U.S. due to drug overdose. Patients that experience a gap in their treatment are at a higher risk for relapse and possible overdose. The insurance industry needs to improve their process for approving medications for patients being treated for opioid addiction.
Hunting, Wendy, "Prior Authorizations and Continued Treatment in Addiction Medicine" (2019). Doctoral Projects. 102.
Available for download on Saturday, July 30, 2022