Christie Signs Nation's Strictest Opioid Treatment Mandate, Prescription Limit

New Jersey Governor Chris Christie today enacted the nation's strictest treatment mandates for opioid addiction and a 5-day limit on the first prescription. The governor called for the plan just over a month ago, when he announced that he would make fighting the scourge of drug addiction the priority for his final year in office.

The bill signing came minutes after the General Assembly voted 64-1, with 5 abstentions, to support the measures. It follows a 33-0 vote in the NJ Senate, highlighting the grave nature of the state’s opioid and heroin crisis. New Jersey reported 1587 drug overdose deaths in 2015, including 918 from heroin, the highest ever recorded. The bill swept through the legislature even though no one knows what it will cost or the effect on premiums—both the legislature’s fiscal office and the NJ Association of Health Plans said they were unable to provide a firm estimate.

“Everyone in New Jersey is impacted by America’s growing drug addiction crisis, and so I am proud bipartisan legislative leaders expedited the passage of this life-saving healthcare reform that will serve as a national model,” Governor Christie said. “Lives will no longer be put at risk by layers of needless bureaucracy or due to an overabundance of prescribed opioid pills that get into the hands of children and the vulnerable. This is no doubt the strongest law in the country that will provide critical prevention and treatment measures to combat the rampant, deadly disease of addiction.”

The bill requires health plans to offer 6 months of treatment, including an initial 28-day period in which health plans cannot deny inpatient care. After that, health plans can do concurrent review no more than every 2 weeks to guide the location of care. NJ-AHP testified that it would not oppose the bill, but wanted to work with the state to maintain principles of accountable care, and to not assume an inpatient setting was best.

Physician groups have raised concerns about interfering with the practice of medicine. The measure is stricter than CDC prescribing guidelines that were updated in March 2016.

Less-noticed, but groundbreaking, parts of the bill require health plans to go out-of-network, if necessary, to ensure that people seeking help are placed within 24 hours. The law, as written, will extend to other forms of substance abuse, not just opioid and heroin addiction.

The measure also includes education requirements for licensed professionals who dispense opioids, from physicians, to dentists, to midwives. Patients with cancer or those in hospice care are exempt from the initial pill limit.

As is the case nationwide, the crisis of opioid addiction is not evenly distributed in New Jersey. Ocean County, along the Jersey Shore, had a 2016 death rate on par with some of the nation’s hardest-hit states. In an earlier interview with The American Journal of Managed Care, Ocean County Prosecutor Joseph D. Coronato said Christie’s plan would address a crucial need: getting people into treatment when they are ready, including after they have been saved from an overdose by Narcan (naloxone)

Said Coronato, “If you don’t get them when the tear drops are warm, that’s a lost opportunity.”

In the Assembly, the bill had support from lleadership in both parties.“While this legislation aims to prevent addiction to begin with, it also recognizes the realities that have taken hold, and substantially bolsters treatment options and health benefits to those that have succumbed to this epidemic,” said Assembly Speaker Vincent Prieto, a Democrat and one ot the law's sponsors. “This is an issue that has touched the lives of nearly every New Jerseyan either directly or indirectly.”

Before the vote, Republican Assemblyman Declan O’Scanlon, one of the legislature’s more conservative members, spoke of the need for the bill as one who has seen the grip of addiction within his own family. O’Scanlon shared that both his brother and mother died of alcoholism, and that addiction is not a “bad habit,” but more like cancer, a chronic condition.

It’s hard to understand, he said, “in order for it to progress, the victim has to be complicit in their own destruction. … It drives some people to the point where they can’t help but commit to slow motion suicide.”

When those who suffer from addiction are finally ready for treatment, O’Scanlon said, it is “beyond devastating” for a “nameless, faceless bureaucrat” from an insurer to say that the person can wait another day. Family members understand that another day in outpatient care could lead to death, he said.

VIDEO: How naloxone programs do more than stop overdoses

Christie blistered health plans in his January address for giving middle-class families the “runaround” when they tried to get care for people in need of treatment for drug addiction. As he did during his campaign for president, Christie recounted the story of his law school classmate’s downward spiral and death from opioid addiction, which began with treatment for back pain.

Rather than fight the bill, health plans sought input on guiding where treatment will occur. Last week, the CEO of the state’s largest insurer, Horizon Blue Cross and Blue Shield of New Jersey, published an op-ed that credited state officials for treating addiction “as a disease—not a behavior, choice, or moral failure.”

“Mandating that insurance policies include a specific benefit requires striking the right balance between affordability and coverage,” Horizon’s CEO, Robert A. Marino, wrote. “I applaud the governor and legislative leaders for working to strike the right balance, engaging all parties to face the problem and advancing a comprehensive solution.”

Horizon was among the payers that contributed to a white paper, published in the CMS website, on what health plans can do to fight opioid addiction. Steps included adherence to CDC prescribing guidelines, making Narcan available, and promoting the use the medication assisted therapy.