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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 gained final legislative approval last night.

“Opioid abuse is at epidemic proportions, and all efforts to develop safer alternatives to highly addictive and abuse-prone drugs should be encouraged,” said Senator Vitale (D-Middlesex). “If we want to enhance prevention and treatment efforts and reduce the costs to society and to our health care system that result from opioid abuse, the first step would be to require health insurers to provide coverage for these innovative abuse-deterring alternatives that are just as effective when taken as prescribed.”

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.

“The ultimate goal is to reduce the abuse of opioid prescription drugs, which often serve as a gateway to heroin,” said Senator Vitale. “While these relatively new drugs with abuse-deterrent qualities are not abuse-proof, they certainly will help us reach our intended goal of merging necessary: pain relief with lower 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 by a vote of 29-8 and the Assembly by 58-13-3. It now heads to the Governor’s desk.

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