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Senator Vitale

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 Commerce Committee today.

“Opioid abuse has reached epidemic proportions, in part due to their low cost and vast coverage by insurance,” said Senator Vitale (D-Middlesex). “To combat the abuse of opioids, drug manufacturers are developing abuse-deterrent opioid drugs that work just as well when taken as prescribed but that make it more difficult to misuse. These drugs should be covered by insurance.”

Opioid analgesic drugs are drugs prescribed to treat moderate to severe pain or other conditions. Abuse-deterrent opioid analgesic drugs are drugs approved by the U.S. Food and Drug Administration with abuse-deterrence labeling claims that indicate the drug is expected to 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 that, if the health insurer provides prescription drug benefits through the use of a tiered system, all abuse-deterrent opioid analgesic drugs would be included on the most preferred tier. Additionally, cost-sharing for abuse-deterrent opioid analgesic drugs would not exceed the lowest cost-sharing level applied to other prescription drugs. Under the bill, any prior authorization requirements or other utilization review measures for opioid analgesic drugs would not require first use of non-abuse-deterrent opioid analgesic drugs in order to access opioid analgesic drugs without abuse-deterrent properties.

“Although these analgesic drugs are not abuse-proof, their development is an important step toward balancing appropriate access  to opioids for patients with pain who need it with the importance of reducing opioid misuse and abuse,” said Senator Vitale.

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 Commerce Committee by a vote of 4-1. It now heads to the full Senate for consideration.

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