NJ Lawmaker Wants Health Insurers to Cover Abuse-Deterrent Opioids
New Jersey is in the throes of an opioid abuse epidemic said state Sen. Joe Vitale (D-Woodbridge). There are abuse-deterrent opioids on the market, but health insurers in the Garden State are not required to cover them. Legislation (S-3036) sponsored by Vitale would change that.
“It is optional and in this case it would be required and it would be the lowest price possible for the patient,” Vitale said. “The abuse deterrent opioids, they’re not fool-proof, but they can deter someone from changing the composition of the pill.”
The abuse-deterrent drugs were approved by the U.S. Food and Drug Administration. They are designed to be difficult to crush so that they can be injected or snorted which gives the user a more intense, addictive and dangerous high.
“Some people have a substance abuse addiction and it’s serious enough, they will either try to split their pills or change the composition of their pills to maximize their impact,” the senator said.
The measure was approved by the Senate Health Committee which is chaired by Vitale on Dec. 21. The New Jersey Business and Industry Association was quick to express staunch opposition.
“NJBIA is concerned about the cost of mandates on business, and in this case health insurers would be required to cover these opioid analgesic drugs on their most preferred tier. As the cost of health benefits continues to rise we are always worried about legislation that drives up employer costs,” said Mary Beaumont, NJBIA vice president of Health and Legal Affairs in an emailed statement.
Beaumont also pointed out the bill was heard in committee before it had been reviewed by the state Mandated Health Benefits Advisory Commission so it wasn’t clear what the true impact of the legislation would be on the cost of health insurance.
“Insurance companies and the business community are concerned it might drive up costs. I don’t think it will. It’s going to save lives,” Vitale predicted.
Under the bill, insurers would be required to cover the drugs under the following circumstances:
- Cost-sharing for abuse-deterrent drugs cannot exceed the lowest cost-sharing level applied to other drugs; and
- If the health insurer provides prescription drug benefits through use of a formulary, all abuse-deterrent drugs must be on the most preferred tier.
The assembly version of the bill (A-4271) was approved by the full lower house June 25, 2015.
According to www.pharmacytimes.com, FDA-approved abuse-deterrent opioids included:
- Exalgo (hydromorphone)
- Nucynta ER (tapentadol)
- Opana ER (oxymorphone)
- Oxecta (oxycodone)
- Xartemis (oxycodone and acetaminophen)