Health experts, lawmakers and residents agree that New Jersey is in the throes of a heroin epidemic. In an effort to combat the problem, one state lawmaker who is also a practicing physician, is now helping a colleague spearhead an effort to require health insurers to cover pain medications designed to reduce addiction and abuse.

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No community is immune to the ongoing heroin problem. Opioid abuse, addiction and overdoses can be found in Garden State cities, small towns and affluent suburbia.

"New Jersey's heroin and opioid addiction and abuse epidemic is real," said Assemblyman Herb Conaway (D-Delran). "It's time to involve the pharmaceutical industry and the insurance industry in this fight. One way we can do this is to ease the access to these abuse-deterrent formulations of narcotics."

A new bill (A-4271) co-sponsored by Conaway and Assemblyman Dan Benson (D-Hamilton) would require insurers to cover abuse-deterrent opioid analgesic drugs. The pain medications were approved by the U.S. Food and Drug Administration to reduce addiction and abuse. They can't be snorted because they can't be crushed or dissolved for a quick high. The drugs are specifically designed as an extended-release deterrent.

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;
  • If the health insurer provides prescription drug benefits through use of a formulary, all abuse-deterrent drugs must be on the most preferred tier

"There is an epidemic and if the insurance side of the world isn't responding to those needs it doesn't happen because it's just too expensive on its own," Benson said. "We understand that medications are expensive and we need to make sure that the marketplace is responding to the needs that are out there in the community."

Opposition from some health insurers centers around added cost and there was also a concern that those costs would be passed on to consumers. Conaway and Benson said they would work with stakeholders to address any issues that exist.

On June 1, the bill was approved by the Assembly Health and Senior Services Committee.

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