Health insurance companies may not impose an “arbitrary limit” on coverage for naloxone, a drug used to treat narcotic overdoses, the Department of Financial Services said in a letter to insurers Sept. 28.
In the letter to insurers, the state agency said that naloxone—which blocks or reverses the effects of opioid medications such as oxycodone and fentanyl—must be covered by insurers when medically necessary.
“Insurers may not impose any arbitrary limits on coverage for naloxone, for example, issuers may not place an annual limit on coverage for an unused naloxone prescription refill (as some issuers may be doing) unless medically warranted,” wrote Lisette Johnson, the bureau chief for DFS’s health bureau.
Because fentanyl is so powerful, an overdose involving the synthetic opioid pain medication deadlier than heroin can result in more than one dose of naloxone being needed to reverse the effects of an overdose, DFS said. Naloxone also is used to treat heroin overdose.
The Health Plan Association, a trade group that represents insurers, said that it was unaware of health insurance plans placing limits on naloxone.
Leslie Moran, the senior vice president of HPA, told the New York Law Journal on Sept. 29, “most of our plans are, as usual, scratching their heads. We were not aware that there is an issue.”
Insurers regulated by the state want the Cuomo administration to reach out to the Office of the Medicaid Inspector General in New York to “relax some of the oversight on plans,” Moran said, because plans could be penalized for fraud and abuse if naloxone is dispensed freely.
“We want to make sure they’re aware of the unintended consequences,” Moran said, further adding that naloxone does have “street value.”
In an effort to crack down on the rise of fentanyl, Gov. Andrew Cuomo announced plans to advance legislation that would add 11 fentanyl analogs to the state controlled-substance schedule. The addition to the list would allow law enforcement officials to go after dealers who manufacture and sell any of the drugs on the list.
“Fentanyl is a new front in New York’s ongoing fight against opioids, and our laws need to stay one step ahead of dealers who distribute this poison,” Cuomo said in a statement. “We need to give law enforcement the tools to hold criminals accountable and keep these dangerous substances off our streets and out of the hands of our children.”
The Medical Society of the State of New York, which represents roughly 30,000 physicians, medical residents and medical students, is supportive of the governor’s efforts to add fentanyl analogs to the list of controlled substances. Dr. William Spencer, a member of the organization and a Suffolk County legislator, told the Law Journal that the analogs being added aren’t used by physicians and are not approved by the U.S. Food and Drug Administration.
“These analogs are synthetic analogs,” Spencer said. “They’re for illicit use only.”
Forty-one state attorneys general, including New York’s Eric Schneiderman, are investigating pharmaceutical companies’ alleged role in the prescription painkiller and heroin addiction epidemic plaguing the nation (NYLJ, Sept. 19). A growing number of counties throughout the state and nationally are also suing pharmaceutical companies over the surge in opioid addiction (NYLJ, May 18).