Bill encouraging insurance companies to cover abuse-deterrent opioids passes first Florida House subcommittee

TALLAHASSEE -- A Florida lawmaker is trying to make it easier for those who need painkillers to have access to opioids that are less likely to cause addiction, and for those looking for medication-assisted treatment for their addictions.

The bill, sponsored by Rep. Jeanette M. Nuñez, R-Miami, was approved Wednesday by the House Health Innovation Subcommittee, 12-1.

The measure would prevent insurance companies from requiring authorization for abuse-deterrent opioids, which can also be used to help manage addictions to opioids such as heroin or other prescription painkillers, unless the insurance company also requires prior authorization for opioids that aren't "abuse deterrent."

Abuse deterrent is a label regulated by the Food and Drug Administration, and typically means the drug is difficult to manipulate, such as by crushing it to snort or shoot it up; doesn't produce a euphoria or high; or causes irritation if used in a way other than directed.

"There's no doubt that opioid abuse is a problem, and I'm not saying this will be a silver bullet to fix that," Nuñez told the subcommittee. "But it's a step to combat this problem."

Manatee and Sarasota counties saw more than 150 deaths in 2015 due to overdoses on heroin and fentanyl, a potent opioid, and there were more than 1,300 overdose calls in Manatee alone. Officials have pointed to the end of Florida's pill mill epidemic -- when doctors were prescribing patients opioids they didn't really need, flooding the streets with cheap prescription pills -- as a major driver of opioid and heroin abuse.

The bill also would not allow insurance companies to require patients to use a non-abuse-deterrent opioid before covering abuse-deterrent opioids, so physicians can prescribe abuse-deterrent opioids as an initial treatment.

It's nearly identical to a bill in the 2015 session that passed all require House and Senate committees before failing when the House ended the session early.

Under current law, insurance companies are allowed to use cost containment policies when deciding what drugs they will cover for enrollees. Two examples of cost containment policies are requiring patients to obtain prior authorization from their plan before getting coverage for a certain drug and making patients try another, typically cheaper, drug and prove that it isn't treating them effectively before the insurance company will cover the cost of a certain drug. The latter is known as a "fail first" policy.

Melissa Larkin-Skinner, chief clinical officer at Centerstone Florida, a mental health and addiction treatment center in Bradenton, said requiring pre-authorization for drugs can act as a deterrent for doctors in prescribing it in the first place, so they will automatically prescribe one that doesn't require authorization.

"So this way, doctors can try to deter abuse right out the gate, rather than insurance companies telling them they have to try an opioid associated with abuse first," Larkin-Skinner said. "That kind of practice makes no sense. And I can't say that I know it's happening, but I wouldn't be surprised."

While it's a good effort to also help those looking for medication assistance for their opioid addictions, Larkin-Skinner said most of their patients aren't insured in the first place. They therefore have to pay out-of-pocket regardless, which is about $150 per month or more.

Pharmaceutical company representatives spoke in support of the bill, saying encouraging prescriptions of abuse-deterrent medications would help drive research and eventually decrease costs of the medications.

But a representative for Express Scripts, the largest pharmacy benefits manager in the U.S., said the bill would serve to drive up insurance premiums and was the equivalent of a drug mandate.

"The way we read this, if we cover any opioids, then you have to cover abuse-deterrent opioids," he said. "I take that as a drug mandate, because no insurance company will stop covering all opioids."

He added that abuse deterrent did not mean they were abuse proof, and there were forums online that discussed ways to get high of abuse-deterrent drugs.

Nuñez didn't respond to him specifically, but said she had not heard from private insurance plans that it would increase cost estimates and that there was no reason to doubt that abuse-deterrent drugs could help those either currently struggling with addiction or prevent people from becoming addicted in the first place.

"There is data that proves these are absolutely effective," Nuñez said.

Kate Irby, Herald online/political reporter, can be reached at 941-745-7055. You can follow her on Twitter@KateIrby

This story was originally published January 13, 2016 at 6:37 PM with the headline "Bill encouraging insurance companies to cover abuse-deterrent opioids passes first Florida House subcommittee ."