Hochul Signs Bill to Remove Barriers to Addiction Treatment

In the latest of a series of steps Hochul has taken to change the direction of drug policy, doctors will no longer have to ask insurance companies for permission to prescribe opioid use disorder medications to Medicaid patients.

Sam Mellins   ·   December 23, 2021
Demonstrators rally for an end to prior authorization in Albany in 2019 | Courtesy of Vocal-NY

On Wednesday, Governor Kathy Hochul signed legislation removing barriers to opioid use disorder treatment for New Yorkers covered by Medicaid—the latest in a series of steps that the new governor has taken to change the direction of drug policy in New York.

State law currently requires doctors to obtain approval from insurance companies before prescribing several of the most used medications for treating opioid addiction to Medicaid beneficiaries, a process known as prior authorization. The law Hochul signed yesterday, which will take effect in 90 days, eliminates such pre-approvals.

Prior authorization for opioid medications can delay treatment by as much as several days, and generally at least by twenty-four hours. Removing it will end these delays, a step that advocates say is especially urgent in light of spiking overdose deaths in New York this year.

The bill eliminates a two-tiered system for addiction treatment created in 2019, when then-Governor Andrew Cuomo signed a bill eliminating prior authorization for commercial insurers but vetoed a similar bill for Medicaid beneficiaries, who are low-income and largely non-white. Cuomo said his veto was on account of the bill’s $30 million cost to the state’s Medicaid program.

A November 2019 report by nonprofit research group RTI International argued that removing prior authorization would actually save the state over $50 million a year, since easier access to medications would prevent more serious health issues requiring costly emergency room and hospital care, such as overdose treatment. The report also found that the policy change would save nearly 600 lives a year.

The bill was passed again by large bipartisan margins in 2021, and was sent to Hochul’s desk in December.

The removal of prior authorization will affect the health care of tens of thousands of New Yorkers. Since December 2019, the number of New Yorkers enrolled in Medicaid has grown by over a million, standing at nearly 7.3 million in November. A 2019 report by the Legal Action Center estimated the number of New York Medicaid beneficiaries diagnosed with an opioid use disorder at over 111,000, and the number using medication to treat such a disorder at over 77,000.

Linda Rosenthal (D-Manhattan), the bill's lead sponsor in the Assembly, celebrated the bill's enactment. “New York lost more people in 2020 to preventable overdose than in any other year that records were kept. Eliminating prior authorization for MAT drugs for people covered by Medicaid represents a historic step forward in our work to end the overdose crisis,” she said in a statement to New York Focus. She and Pete Harckham (D-Putnam), the bill's lead sponsor in the Senate, have also sponsored several other measures to combat addiction and overdose in recent years.

Advocates of medication-based treatment for opioid use disorder praised Hochul for signing the bill. “We’re thrilled Governor Hochul has shown her full commitment to reducing overdose fatalities and empowering recovery in New York by signing this lifesaving bill,” said Alexis Pleus, executive director of drug policy organization Truth Pharm.

“It really does signal that she’s pulling New York out of the dark era under Cuomo,” said Jasmine Budnella, director of drug policy at VOCAL-NY.

Reached by phone on Thursday, Budnella described the three year fight that led up to the bill’s passage. “I’m visiting my family for the holidays,” she said. “During this exact time in 2019, I was visiting home and was negotiating this bill!”

Harm reduction advocates have been similarly pleased with Hochul’s choices to run the state’s health and addiction services departments, which mark a departure from the Cuomo administration’s approach to health and drug policy.

In September, Hochul appointed Dr. Mary Bassett, a long time advocate of health equity and drug user health, to run the state health department. In November, Hochul appointed Dr. Chinazo Cunningham, a longtime proponent of drug user health and medication-based treatment of opioid addiction, as commissioner of New York’s addiction services agency.

“I’m really thankful that we have a new administration in office,” said Dr. Justine Waldman, an Ithaca-based emergency medicine physician who treats patients for opioid use disorder. “So far, [Hochul] has really demonstrated a push for health equity.”

In October, Hochul also signed bills to decriminalize syringe possession and increase access to opioid addiction treatment in prisons and jails. New York City authorized two overdose prevention sites, which Cuomo had held up for years, after Hochul took office; advocates plan to push Hochul to authorize the sites across the state in 2022.

The removal of prior authorization for Medicaid beneficiaries was not signed into law along with those bills, even as the issue took on new salience this fall. On October 1, the state health department changed its list of which opioid medications require doctors to obtain approval from insurers before prescribing them to Medicaid beneficiaries.

The point of the change, which was passed into law as part of the state’s 2020 budget, was to create uniformity across New York’s Medicaid system. But the result was widespread confusion and difficulty accessing treatment for some patients, as pharmacies and patients were unready for the change, several treatment providers and advocates told New York Focus.

“Communication at the pharmacy level wasn’t well prepared, frankly. Patients would go in and didn’t realize that they needed prior authorization,” said Allegra Schorr, president of the Coalition of Medication-Assisted Treatment Providers and Advocates.

Waldman said that multiple patients of hers have had their prescriptions rejected since October 1. “We’re basically getting [prescriptions] kicked back over and over again,’ she said.

The shift also increased the administrative burden on providers, who had to spend more time seeking approvals to prescribe several types of opioid medication and redoing such approvals for patients switching to now-approved medications. Waldman estimated that her staff has spent 50 to 75 percent more time seeking such approvals since the new rules went into effect.

Once the new law takes effect in 90 days, these barriers and delays will cease to exist.

Sam Mellins is senior reporter at New York Focus, which he has been a part of since launch day. His reporting has also appeared in The San Francisco Chronicle, The Intercept, THE CITY, and The Nation. 
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