State Laws Banning Prior Authorization For Medications For Opioid Use Disorder Increased Substantially, 2015-23.

Prior authorization is a barrier to accessing medications for opioid use disorder (MOUD). Although private insurance covered about one-third of patients with OUD in 2023, the understanding of prior authorization prohibitions in private insurance remains limited. We synthesized state laws prohibiting prior authorization for MOUD in private insurance in the US. The number of states with such prohibitions grew from two in 2015 to twenty-two in 2023, with variations in the scope of these prohibitions. Seven states have fully prohibited prior authorization for all MOUD ("full prohibitions") since the effective date. Fifteen states adopted legislation that still allows prior authorization under some conditions ("partial prohibitions," including those covering at least one of any MOUD; those covering one of each MOUD; and those with limitations based on modality or formulation, generic or branded status, prior authorization frequency, prescription duration, or emergency conditions). Among these fifteen states, four states transitioned from partial prohibitions to full prohibitions, and eleven states maintained partial prohibitions, although many have broadened the scope of prohibitions over time. The proliferation of prior authorization prohibitions for MOUD highlights that this is an area of significant state legislative focus.