The Senate on Tuesday unanimously approved legislation to increase opportunities for long-term substance abuse recovery in the Commonwealth by supporting a continuum of care and removing barriers that stand in the way of effective treatment, Senator Jason Lewis announced.
“Opiate addiction in the Commonwealth has reached crisis level, and we need to take aggressive steps to prevent and treat addiction,” noted Senator Lewis. “With no community and no family immune to the reach of this epidemic, we must expand access to treatment. I’m proud to support this important legislation that both improves access to treatment and eliminates obstacles to treatment.”
To curb the public health risk of Schedule II and III drugs, the bill requires the Drug Formulary Commission to prepare a drug formulary of appropriate substitutions, which must include abuse deterrent properties and consideration of cost and accessibility for consumers. Insurance carriers are required to cover abuse deterrent drugs listed on the formulary in the same manner that they cover non-abuse deterrent drugs and cannot impose additional cost burdens on consumers who receive abuse deterrent drugs.
If there is no abuse deterrent substitution available, the Commissioner of the Department of Public Health can issue regulations related to the drug, including mandating that a physician review the patient’s prescription history, check the Prescription Monitoring Program, educate the patient on addiction, limit the quantity of pills and conduct a risk assessment before prescribing. The Commissioner is also authorized to schedule a substance as Schedule I for up to one year if it poses an imminent hazard to public safety and is not already listed in a different schedule.
The bill strengthens the Prescription Monitoring Program by requiring physicians to receive training on the Program before renewing their licenses. It also requires them to consult with the Program before writing a prescription on an annual basis for patients who receive ongoing treatment of a controlled substance and before writing a new or replacement prescription.
In the event that a death is caused by a controlled substance, the Chief Medical Examiner is required to file a report with the FDA’s MedWatch Program and the Department of Public Health and directs DPH to review the Program upon receiving a report.
The bill creates a commission to review prescription painkiller limitations by insurance carriers, including the system implemented by Blue Cross Blue Shield, and report recommendations and proposed legislation to the Legislature.
The bill also does the following to increase the quality of and access to treatment:
• Removes prior authorization for Acute Treatment Services for all MassHealth Managed Care Entities and requires coverage of up to 15 days of Clinical Stabilization Services;
• Removes prior authorization for Acute Treatment Services and Clinical Stabilization Services for commercial insurers and requires coverage for a total of up to 21 days before engaging in utilization management activities;
• Directs the Health Policy Commission, in consultation with the Department of Public Health, to determine standards for evidence-based, effective substance abuse treatment with high quality outcomes and create a certification process for providers, and once certified, insurance carriers are prohibited from requiring prior authorization for services offered by a certified provider; and,
• Requires all insurance carriers to reimburse for substance abuse treatment services delivered by a Licensed Alcohol and Drug Counselor.
In addition, it directs the Center for Health Information and Analysis to review the accessibility of substance abuse treatment and adequacy of insurance coverage and tasks the Health Policy Commission with recommending policies to ensure access and coverage for substance abuse treatment throughout the Commonwealth, as well as review denial rates for substance abuse treatment coverage by commercial insurers.
The bill will now go to the House for consideration.