Aetna has just made a national policy change for all of their commercial members regarding the prescription of Narcan, starting January 1, 2018.
Narcan, a medication used to block the effects of opioids, in particularly for overdoses, has previously required copays for Aetna members. Aetna surveyed the prescription fill of Narcan by their commercial members and found that members had access barriers with the high copays. When the copays were reduced, prescription fills of the medication increased.
In acknowledging the need and use of Narcan during critical episodes of the addiction, Aetna has made a policy change that is critical across all States.
While in some States, legislative actions has lead to the availability of Narcan without a prescription; in other States, legislative actions has lead to defined treatment lengths for addiction treatment at critical levels of care without preauthorization requirements.
The move by Aetna, however, goes deep into the spirit of which MHPAEA was drafted. The presenting question in this policy change is whether formulary designs are truly in parity across medical/surgical and behavioral health and addiction treatment.
If Narcan can bring an individual back from a near episode of death, could it be considered similar to nitrogylcerin? As such, are availability of formulary designs transparent and compliant for the access of behavioral health and addiction treatment?
SAE’s parity team can be available for technical assistance to address global and local parity compliance initiatives.