January 09, 2018
On Dec. 19, 2017, the Massachusetts Division of Insurance published Bulletin 2017-08. The new bulletin relates to coverage for abuse-deterrent opioid drug products. According to the bulletin, MA law requires that if health insurance is considered “creditable” (as compared to Medicare’s prescription drug coverage), the insurance must provide coverage for abuse-deterrent opioid drugs on the formulary on a basis not less favorable than non-abuse-deterrent opioid drug products covered under the insurance. Thus, plan designs may not provide coverage for abuse-deterrent opioid drugs in a way that is less favorable. For example, for a health plan with differing copays based on the benefit tier of which a drug product is assigned, the carrier must charge the same cost-sharing for an abuse-deterrent drug product as the non-abuse-deterrent drug product that the Drug Formulary Commission (DFC) identifies as chemically equivalent to an abuse-deterrent product. For those abuse-deterrent drug products where DFC hasn’t identified a non-abuse-deterrent equivalent, the carrier is not restricted as to the benefit tier to which the abuse-deterrent drug product is assigned. This includes all utilization processes, including (but not limited to) prior authorization, concurrent review and step therapies.
According to the bulletin, carriers may employ medical management and utilization review processes as permitted under federal and state law, but they’re required to employ systems that don’t treat abuse-deterrent drug products in a manner less favorable than used for non-abuse-deterrent drug products. The bulletin includes a formulary of chemically equivalent substitutions for opioids with a heightened public health risk, which includes the non-abuse-deterrent drug products and their interchangeable abuse-deterrent drug product.
Employers don’t need to do anything new to comply with the bulletin, but they should be aware of the abuse-deterrent opioid drug coverage requirements, should they come up with the carrier or with employees.
Bulletin 2017-08 »