BOSTON – State Senator Benjamin B. Downing (D- Pittsfield) announces the passage of unanimously approved legislation in the Senate today to increase opportunities for long-term substance abuse recovery in the Commonwealth. The legislation supports a continuum of care and removes barriers that stand in the way of effective treatment.
“Massachusetts is experiencing a crisis in opiate addiction, and the time to act is now,” said Downing. “Addiction levels are at the highest in history, reaching to every community, ripping apart families and damaging futures of our young people. This bill outlines steps we can take to increase treatment and create a continuum of care that addresses the public health, public safety and economic impact of this epidemic.”
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.
To 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 of Representatives for consideration.