Pilot Grant Analysis Examines Prior Authorization Trends for MOUD in Private Insurance
Researchers observed a positive trend towards removing prior authorization requirements for MOUD.
There is a growing body of research illustrating a movement to remove prior authorization for medications for opioid use disorder (MOUD).
Prior authorization requires providers to request approval from an insurer before providing a medication or service. This process is historically enforced for a wide range of medications, including certain MOUD, and has been found to discourage clinicians from treating patients and make it harder for individuals to seek or continue care.
Existing studies on policies regulating prior authorization for MOUD in the last decade mainly focus on Medicare and Medicaid, but have yet to explore the landscape in private insurance, which covers nearly 1 in 3 patients with opioid use disorder (OUD).
To address this gap, lead author and former CHERISH pilot grantee Allison Ju-Chen Hu and CHERISH-affiliated researchers published an analysis of state laws that prohibit private insurance plans from requiring prior authorization for MOUD. The research team created a longitudinal dataset and tracked changes in laws regulating prior authorizations for MOUD in private insurance from January 2015 to December 2023. They classified these laws into two groups: full prohibitions, where prior authorization is entirely banned for all MOUD, and partial prohibitions, where private insurance can still require prior authorization for MOUD in certain conditions.
Allison Ju-Chen Hu, PhD
Allison Ju-Chen Hu is a health services researcher and currently an assistant professor in the Department of Health Policy and Management at Tulane University Celia Scott Weatherhead School of Public Health and Tropical Medicine.
Key Findings
Researchers observed a notable increase in the number of states with legislative prior authorization prohibition for MOUD in private insurance from 2015 to 2023. Among states with such prohibitions, they observed a positive trend of moving toward full prohibitions or expanding the scope of existing prohibitions over time.
- The number of U.S. states that adopted prior authorization prohibition laws grew from 2 to 22 between 2015 and 2023, with variations in scope.
- Among the 22 states with prohibition laws: 7 states adopted full prohibitions for all MOUD, and 15 states had partial prohibitions which allowed prior authorization under certain conditions.
- Among the 15 states with partial prohibitions: 4 states transitioned to adopt full prohibitions by the end of 2023.
The analysis led by Hu and colleagues demonstrates a growing trend in state legislative efforts to remove prior authorization for MOUD in private insurance plans. The authors highlight that amending prior authorization for MOUD will be a legislative focus as state decision-makers and healthcare providers examine ways to address the opioid overdose epidemic and improve access to MOUD. Authors encourage future studies to examine the effects of prior authorization prohibitions on insurance compliance, access to MOUD, and OUD treatment outcomes.
This study, State Laws Banning Prior Authorization For Medications For Opioid Use Disorder Increased Substantially, 2015–23, was published in Health Affairs on November 3, 2025, and is supported, in part, by a CHERISH pilot grant awarded to Allison Ju-Chen Hu in 2024. Co-authors include CHERISH Methodology Core Co-director Ali Jalali, CHERISH Research Affiliate Shashi Kapadia, CHERISH Pilot Grant, Mentoring & Training Core Director Yuhua Bao, and Weill Cornell Medicine colleagues Kayla Hutchings and Kristin Underhill.