NJ lawmakers say they’ll move quickly on mandating drug-rehab coverage

Among the addiction-related proposals Gov. Chris Christie made Tuesday in his State of the State, two received the most attention: one that lawmakers promise to act on quickly; another that he’s working around them to avoid an influential legislator who is opposed.

Perhaps only one of Christie’s plans appears to need legislative action – a mandate requiring health insurers to cover six months of inpatient or outpatient drug rehabilitation treatment.

Christie said middle-class families are at the whim of insurers, and he said companies too often deny coverage. He said wealthy families have always been able to afford drug treatment when it’s needed, and poor families now have more access due to Medicaid expansion under the Affordable Care Act.

“Whether your child lives or dies should not be the subject of a denial letter from an insurance company,” Christie said.

“Rather than support and compassion and coverage, they’re too often met by questioning and red tape and denials by insurers who happily take their premiums at the same time,” Christie said. “No more pre-approvals. No more medical necessity reviews prior to admission by an insurance company bureaucrat. No more denials that can cost lives. Treatment first, hope first, denials last.”

Legislative leaders appear willing and eager to act. Assembly Minority Leader Jon Bramnick says he’ll introduce the bill. Speaker Vincent Prieto says he’s proud to work on it. Senate President Steve Sweeney says he’ll do all he can to get it done in 30 days, as Christie seeks.

"It's time to end the insurance company run-around," Bramnick said. “Denial should no longer be an option that blocks people from getting the treatment they need.”

“It’s the right thing to do,” Sweeney said. “He stated it as well as you can, there’s too many families that can’t get their loved ones where they need it. And insurance companies are always interfering, looking at their bottom line rather than people.”

Health insurers say they’ll work with Christie and lawmakers but appear to be waiting until they see the actual legislation for a more detailed response.

“Horizon Blue Cross Blue Shield of New Jersey has a long history of helping New Jersey combat the addiction epidemic,” said Tom Wilson, the company’s director of public affairs. “We are eager to work with Gov. Christie and the legislature to ensure that those who need and want help ending their addiction have the opportunity to obtain affordable and appropriate treatment.”

In Toms River on Wednesday, Christie said when he first told the Department of Banking and Insurance two months ago he wanted to propose the new mandate, they responded with a seven-page memo detailing why he should not. He sent them back to figure out a way to make it happen.

Four out of five new heroin users got started by abusing painkillers, according to the American Society of Addiction Medicine. Christie said addictions can be cut off before they start by limiting first-time prescriptions for opioids such as Percocet or Vicodin to five days.

Currently, a 30-day supply is allowed.

“This is dangerous. It’s ill-advised. And it is absolutely unnecessary in a state like ours. We know addiction to opioids can occur within days,” Christie said.

The Senate has voted for a seven-day limit, which is the rule for first-time opioid prescriptions in Connecticut, Maine, Massachusetts, New York and Rhode Island.

But the bill has stalled in the Assembly Health Committee, where chairman Assemblyman Herb Conaway, D-Burlington, who is a medical doctor, says it could hurt some patients and interfere with doctors.

Christie intends to make the change administratively, not through the Legislature. He directed his attorney general, Christopher Porrino, to make the change using emergency rule-making and other regulatory changes.

Assemblywoman Shavonda Sumter, D-Passaic, said the benefits could be significant.

“That may be a game-changer for us,” Sumter said.

Sweeney said it’s an important issue many families confront, and he described an experience when bringing his son to a hospital for care when he injured his back.

“I said, ‘What is that, doc?’ He said, ‘It’s Oxycontin,’ and I said, ‘Are you out of your mind?’ Then he said, ‘Well how about Percocet?’ I said, ‘How about Motrin?’” Sweeney said. “It’s that simple. My son would have took those pills. And they were giving him a month supply.”

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Michael Symons is State House bureau chief for New Jersey 101.5 and the editor of New Jersey: Decoded. Follow @NJDecoded on Twitter and Facebook. Contact him at michael.symons@townsquaremedia.com