Last week, over 1,000 state health policy leaders and others from every state joined the National Academy for State Health Policy’s (NASHP) first-ever virtual state health policy conference to discuss a path forward during an unrelenting pandemic and profound budget challenges. As one state official noted, “This was a chance to lift my eyes from the day-to-day challenges and look at the big picture.”
On June 22, 2016, New York Governor Andrew Cuomo signed a package of seven bills related to opioids and treatment for opioid addiction. The legislation, which includes recommendations from the governor’s Heroin and Opioid Task Force, is aimed at combatting the heroin and opioid crisis affecting the state. The state’s FY2017 budget includes nearly $200 million in funding for opioid treatment, which will add 270 treatment beds and more than 2,300 opioid treatment program slots across the state. Additional information is included in Gov. Cuomo’s full press release.
A summary of major provisions within the bills: (Note: To search for individual laws click here.)
Provisions affecting providers and pharmacies:
- First-time Opioid Prescribing Limits for Acute Pain: Chapter 71 of the Laws of 2016 limits first time opioid prescriptions for acute pain to no more than a seven-day supply. Providers may subsequently issue 30-day opioid prescriptions thereafter if the prescription is meant for the same pain. This limit does not apply to chronic pain, including pain associated with cancer, hospice/end-of-life care, or palliative care. Health plans may charge a prorated copayment for the limited supply; alternatively, a health plan may charge the full copayment so long as additional cost sharing requirements are waived for the subsequent 30-day supply.
- Provider Education Requirements: Chapter 71 of the Laws of 2016 requires licensed professionals who prescribe controlled substances to complete a cumulative three hours of continuing education and training in pain management, palliative care, and addiction every three years. In limited cases, the Department of Health may exempt licensed prescribers from this requirement.
- Hospital Substance Use Disorder Policies and Procedures: Chapter 70 of the Laws of 2016 requires the Commissioner of Health to promulgate regulations requiring hospitals to develop and maintain written policies and procedures for identifying, assessing, and referring individuals with—or at risk of—a substance use disorder. Hospitals are also required to provide such individuals with information regarding available substance use disorder treatments. The Office of Alcoholism and Substance Abuse Services is charged with developing relevant materials that hospitals can disseminate.
- Discharge Planning Requirements: Chapter 69 of the Laws of 2016 requires healthcare facilities providing substance use treatment services to develop a discharge plan in collaboration with the individual receiving treatment; a discharge plan must be complete and reviewed by the individual’s multi-disciplinary care team before the individual can be discharged.
- Public Educational Materials: Chapter 71 of the Laws of 2016 requires the Commissioner of Alcoholism and Substance Abuse Services, in consultation with the Commissioner of Health, to develop educational materials about controlled substances that include information on the risks of misuse, treatment resources available, and proper disposal of unused medications. Pharmacies will be required to distribute these materials to individuals when dispensing opioids.
Provisions affecting insurers:
- Insurance Mandates for Substance Use Disorder Treatment: Chapter 71 of the Laws of 2016 requires commercial health plans to cover unlimited medically-necessary inpatient substance use disorder treatment services provided in residential settings. The law further stipulates that cost sharing and utilization review requirements for these services may not be more restrictive than those used for medical and surgical benefits (i.e., a parity requirement). The law further stipulates that insurers may not require preauthorization nor concurrent utilization review for the first 14 days of treatment. The latter only applies if the treatment facility notifies the insurer of the admission and treatment plan within 48 hours of an admission. The treatment facility is required to conduct daily clinical review of the patient to ensure the treatment is medically necessary. Health plans may ultimately deny coverage if the services are not medically necessary based on an evidence-based clinical review tool approved by the state’s Office of Alcoholism and Substance Abuse Services. If the services are denied, an individual is not liable for any cost sharing beyond the copayment, coinsurance, or deductible required under the policy.
Similarly, Chapter 69 of the Laws of 2016 forbids commercial health plans from requiring prior authorization for a five-day emergency supply of substance use disorder medication (e.g., buprenorphine) or opioid overdose reversal medication (e.g., naloxone). Health plans may apply cost sharing requirements to the medication, with the caveat that health plans may not apply additional cost sharing if an individual receives a 30-day supply of the medication in the same month in which the emergency supply was dispensed. However, if the insurer prorated cost sharing for the partial-month supply, the health plan may charge up to the remaining amount of a 30-day supply when the second prescription is dispensed. The law also forbids Medicaid managed care plans from requiring prior authorization for buprenorphine or injectable naltrexone when used for detoxification or maintenance treatment of opioid addiction unless the medication is for a non-preferred or non-formulary from of the drug.
Provisions concerning naloxone:
- Third-party Prescribing for Naloxone: Chapter 65 of the Laws of 2016 requires pharmacies with twenty or more locations in the state to either: 1) enter into collaborative practice agreements to provide third-party prescriptions for naloxone or 2) register with the New York State Department of Health (NYSDOH) as an opioid overdose prevention program (which receive naloxone from NYSDOH). Third party prescribing for naloxone has been allowed since April 2006.
- Opioid Antagonists in Public Libraries: Chapter 68 of the Laws of 2016 expands the entities allowed to administer opioid overdose prevention programs to include public libraries.
- Naloxone Exemption for Professional Misconduct: Chapter 70 of the Laws of 2016 stipulates that licensed individuals who would otherwise be prohibited from prescribing or administering drugs administering opioid antagonists may administer opioid antagonists during an emergency.
- Public Data Reporting Requirements: Chapter 66 of the Laws of 2016, as amended by Chapter 70 of the Laws of 2016, updates NYSDOH reporting requirements. The Commissioner of Health is now required to publish county-level opioid overdose data on a quarterly basis. The law includes language stipulating the data must be made available on NYSDOH’s website.
- Medication-Assisted Treatment in Judicial Diversion Programs: Chapter 67 of the Laws of 2016 stipulates that courts are not permitted to require a specific type or brand of drug in a judicial diversion program.