ocal legislators including Sen. Tom Kennedy last week announced passage of landmark legislation that takes a major step forward for substance abuse treatment in Massachusetts.
The bi-partisan bill, now on the governor’s desk, removes barriers that stand in the way of effective substance abuse treatment by allowing patients access to detox and rehab programs without requiring insurance pre-authorization. The bill also strengthens the state’s Prescription Monitoring Program and requires that prescription painkillers only be dispensed in abuse deterrent format, unless otherwise directed by a physician.
“Opiate addiction is really an unprecedented public health crisis,” said Sen. Kennedy. “In addition to all the social costs and devastating pain this can cause our friends and families, there is a monetary cost. We are seeing individuals show up in emergency rooms or even getting sectioned in the House of Correction because it’s the only way they know to get substance abuse treatment. This new law helps to change that.”
“The rising level of opiate addiction in recent years has proven that substance abuse has affected a great number of families in our communities,” said Senator Tom Kennedy. “This new law makes major improvements in the way we treat this disease and those who suffer from it.”
“The impact of addiction is evident every day, whether it’s in the news, in our workplace or even in our own families and I know we all ask ourselves, ‘What can be done to solve this problem?’ The passage of this legislation means that more resources, faster treatment and long-term solutions are now in hand, as well as our ability to target and stop the spread of the dangerous drugs that devastate our communities.”
The bill also authorizes the Department of Public Health (DPH) 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.
To curb the public health risk of Schedule II and III drugs, the bill requires the state’s Drug Formulary Commission to prepare a drug formulary of chemically equivalent substitutions, which must include abuse deterrent properties and must take into consideration 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.
The bill strengthens the Prescription Monitoring Program by requiring the Department of Public Health to report on whether physicians are consulting the state’s database of controlled-substances prescriptions, known as the Prescription Monitoring Program, to see if their patients are obtaining prescriptions from multiple doctors.
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.
This bill both increases access to care and improves the standard of care by removing prior authorization for substance abuse treatment if the provider is certified or licensed by DPH. It also does the following:
• Removes prior authorization for Acute Treatment Services for all MassHealth Managed Care Entities and requires coverage of up to 14 days of Clinical Stabilization Services with utilization review procedures beginning on day seven;
• Removes prior authorization for Acute Treatment Services and Clinical Stabilization Services for commercial insurers and requires coverage for a total of up to 14 days with utilization review procedures beginning on day seven;
• Requires medical necessity of substance abuse treatment to be determined by the treating clinician in consultation with patient; 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.