Would Mandate Coverage for Opioid Drugs with Abuse-Deterrent Properties
TRENTON – Legislation sponsored by Senator Joseph F. Vitale that aims to combat prescription opioid abuse by requiring health insurers to provide coverage for certain prescribed abuse-deterrent opioid drugs cleared the Senate Budget and Appropriations Committee today.
“Opioid abuse has reached all-time highs, and efforts are well underway to develop safer alternatives to highly addictive and abuse-prone drugs,” said Senator Vitale (D-Middlesex). “Abuse-deterrent alternatives work just as well when taken as prescribed but are more difficult to misuse. They should not only be covered by insurance but encouraged to aid prevention and treatment efforts which will reduce long-term costs as we collectively battle this epidemic.”
Opioid analgesic drugs are drugs prescribed to treat moderate to severe pain or other conditions. Abuse-deterrent opioid analgesic drugs are brand or generic drugs approved by the U.S. Food and Drug Administration with abuse-deterrence labeling claims that indicate the drug is expected to deter or result in a meaningful reduction in abuse. Deterrents include formulations that make it difficult to crush and therefore snort or inject for an intense high.
The bill, S-3036, would require health insurers to provide coverage on the insurer’s formulary, drug list, or other lists of similar construct, for at least one prescribed abuse-deterrent opioid analgesic drug product per opioid analgesic active ingredient. Additionally, cost-sharing for generic or brand name abuse-deterrent opioid analgesic drugs would not exceed the lowest cost-sharing level applied to the respective generic or brand name non-abuse-deterrent opioid drugs covered under the contract. An increase in patient cost sharing or disincentives for a subscriber or dispenser would not be allowed to achieve compliance with the bill’s provisions.
Under the bill, any prior authorization requirements or other utilization review measures for opioid analgesic drugs, and any service denials, would not require first use of non-abuse-deterrent opioid analgesic drugs in order to access opioid analgesic drugs without abuse-deterrent properties.
“It is important that we strike a balance between access to opioids for patients with valid needs and with the priority of reducing opioid misuse and abuse,” said Senator Vitale. “These analgesic drugs with abuse-deterrent qualities, while not entirely abuse-proof, merge both intended outcomes: pain relief for those who need it and significantly reduced risks of misuse.”
According to the Centers for Disease Control and Prevention, 44 people die from prescription painkiller overdose in the United States each day. Additionally, the abuse and misuse of opioids is estimated to cost the U.S. $560 billion to $635 billion annually, including lost wages and productivity. This includes around $72 billion in additional healthcare costs.
Massachusetts, Maine and Maryland have enacted laws requiring insurance coverage for abuse-deterrent opioids. Nineteen other states, including New York, California, and Connecticut have legislation pending regarding coverage for abuse-deterrent opioids.
The bill cleared the Senate Budget and Appropriations Committee by a vote of 8-4. It now heads to the full Senate for consideration.