New Bulletin Addresses Coverage for Naloxone

On August 29, 2019, the Division of Insurance published Bulletin 2019-05, which relates to coverage for naloxone. As background, as part of Massachusetts’ commitment to addressing the opioid epidemic, the Department of Public Health issued a statewide standing order for the broad distribution of naloxone and other opioid antagonists to any Massachusetts resident. The bulletin is meant to provide guidance to carriers regarding that standing order.

According to the bulletin, an "opioid antagonist" means "naloxone or any other drug approved by the [FDA] as a competitive narcotic antagonist used in the reversal of overdoses caused by opioids." The bulletin requires carriers to take whatever steps are necessary to modify their systems so that covered persons can obtain naloxone without the need to present a prescription written to the covered person. The bulletin states that the Division would consider it appropriate if carriers establish criteria that only require covered persons to go through prior authorization if they seek to obtain more than two naloxone kits per member within a 30-day period (if the person wants more than two kits within that 30-day period, the carrier could utilize prior authorization).

The bulletin contains no new employer obligations. Employers with fully insured plans in Massachusetts, though, will want to be aware of the coverage requirements and the general focus on coverage of naloxone and other opioid antagonists.

Bulletin 2019-05 »