News from Attorney General Eric T. Schneiderman

FOR IMMEDIATE RELEASE
January 19, 2017

New York City Press Office / 212-416-8060
Albany Press Office / 518-776-2427
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A.G. SCHNEIDERMAN ANNOUNCES NATIONAL SETTLEMENT WITH ANTHEM TO DISCONTINUE
PRE-AUTHORIZATION FOR OPIOID ADDICTION TREATMENT DRUGS

Following Agreement With Cigna, Anthem Is Second Settlement Attorney
General Schneiderman Has Reached To Remove Barriers and Expand Access To
Life-Saving Treatment For Opioid Use Disorder

Empire BlueCross BlueShield Will Also Launch Initiative In New York To
Expand Access To Opioid Addiction Treatment Drugs

NEW YORK – Attorney General Eric T. Schneiderman today announced that
Anthem, the second largest health insurer in the country, will end its
policy of requiring prior authorization for medication-assisted treatment
(“MAT”) for opioid use disorder. The agreement includes Empire BlueCross
BlueShield (BCBS), which insures over 4 million New Yorkers, and resolves
Attorney General Schneiderman’s investigation of prior authorization
practices and network adequacy for MAT treatment. The agreement comes
several months after Attorney General Schneiderman announced a similar
agreement with Cigna.

MAT, when prescribed and monitored properly, has proved effective in
helping patients recover from opioid use disorder, and is both safe and
cost-effective to reduce the risk of overdose. This policy change will
apply not only to most Anthem members in New York, but nationally as well.

“We’re facing an opioid crisis in New York and around the country – and we
should be doing whatever we can to make lifesaving treatments accessible to
those suffering from addiction,” said *Attorney General Schneiderman*. “I
am pleased that this is the second national settlement my office has
reached with major insurers to remove hurdles to opioid addiction
treatment. While we’ve made progress, there are too many still suffering.
We’re committed to continue working with health insurers across the country
to eliminate barriers to lifesaving opioid addiction treatments.”

Anthem required providers to submit a prior approval form for MAT coverage
requests, which required the providers — who had already received specific
training regarding MAT and federal authorization to prescribe these drugs
— to answer numerous questions about the patient’s current treatment and
medication history. The Attorney General’s investigation revealed that
Empire BCBS denied nearly 8% of the overall requests for coverage of MAT in
2015 and the first half of 2016. This subsequently caused significant
delays in patients obtaining treatment for addiction – or patients never
obtaining the treatment at all.

In contrast to its policy for drugs to treat opioid use disorder, Empire
BCBS does not require prior authorization for the majority of drugs it
covers for medical conditions. In particular, Empire BCBS does not require
prior authorization for powerful opioids, including fentanyl, morphine,
tramadol, and oxycodone, when prescribed for pain. These disparities are
not consistent with the New York and federal mental health parity laws,
which require health plans to cover mental health and substance use
disorder treatment the same way they cover treatment for physical
conditions.

Under the agreement, Empire BCBS will also launch an initiative to expand
access to MAT for members in its New York service area. Empire BCBS will
conduct provider outreach and education regarding the benefits of MAT,
informing qualified health care providers how they can obtain certification
from the Substance Abuse and Mental Health Services Administration
(“SAMHSA”) to prescribe buprenorphine and buprenorphine/naloxone as part of
MAT for opioid dependence. Empire BCBS will provide the Attorney General
with a list of MAT providers who have joined its network as a result of
this initiative.

Unlike methadone treatment, which must be administered in a highly
structured clinic, MAT medications, usually containing buprenorphine and
naloxone, may be prescribed or dispensed in physicians’ offices to treat
opioid use disorder, provided the treating physician has obtained the
appropriate certification and has been issued a special DEA license. In
addition to the medication component, psychosocial therapy and management
of medical issues are also recommended components of MAT to treat opioid
use disorder.

Buprenorphine is an opioid partial agonist, meaning that it has lesser
euphoric effects than full opioid agonists such as heroin. At low doses,
buprenorphine produces sufficient agonist effects to enable opioid-addicted
individuals to discontinue the misuse of opioids without experiencing
withdrawal symptoms. Buprenorphine carries a lower risk of abuse,
addiction, and side effects when compared with full opioid agonists.
Naloxone is an opioid antagonist that can be added to buprenorphine that
will decrease the likelihood of diversion and misuse of the combination
drug product. If the combination drug product is crushed and injected the
naloxone and can bring on opioid withdrawal, which serves as a deterrent to
diversion and misuse.

The Centers for Disease Control and Prevention considers MAT a proven,
effective treatment for individuals with an opioid use disorder. MAT has
been shown to increase treatment retention and to reduce opioid use. One
study showed that for half the patients treated with buprenorphine/naloxone
for addiction to prescription opioids, they were abstinent from the drugs
18 months after starting MAT, and after three and a half years, 61% of the
patients reported abstinence from illicit opioids. MAT is supported and
endorsed by the CDC, the Substance Abuse and Mental Health Services
Administration (SAMHSA), the American Society of Addiction Medicine (ASAM),
the New York State Office of Alcoholism and Substance Abuse Services
(OASAS) and the New York City Department of Health and Mental Hygiene
(NYCDOHMH) as a treatment for opioid addiction.

In a recently issued report, the Centers for Disease Control (CDC) reports
that more than 33,000 people nationally died from opioid overdoses. In New
York in 2015, there were almost 2,800 OMIT[opioid] overdose deaths, with
overdose deaths from synthetic opioids (such as fentanyl) increasing by
135% from 2014, and heroin overdose deaths increasing by 29% from 2014.

Addressing access barriers to MAT is just the latest step that Attorney
General Eric T. Schneiderman has taken to address the opioid addiction
crisis. In June of 2011, Attorney General Schneiderman introduced state
legislation for I-STOP, an online Prescription Monitoring Program or a
“PMP,” that enables doctors and pharmacists to report and track controlled
narcotics in real time. I-STOP became effective in August of 2013, making
New York State one of the first states to establish such a PMP, and has
reduced “doctor-shopping” by 75%. The OAG has also aggressively enforced
laws that require parity in health plan coverage of mental health and
addiction treatment, reaching agreements with six companies, including
Anthem, MVP Healthcare, EmblemHealth, Excellus, Beacon Health Options, and
HealthNow. Most recently, in October 2016, the Attorney General announced a
national agreement with Cigna, which agreed to remove prior authorization
requirements for MAT. The Attorney General’s Office has prosecuted many
individuals who have engaged in the illegal distribution and sale of
narcotics as well as health care providers who illegally prescribed and
diverted opioids. The OAG’s Community Overdose Prevention (COP) Program,
which equips New York law enforcement agencies with a life-saving heroin
overdose antidote, has saved more than 100 lives. The OAG has also reached
agreements with Purdue Pharma and Endo Pharmaceuticals Inc., to ensure that
these opioid makers engage in responsible and legal marketing.

Anthem’s policy change follows efforts by both New York State and the
federal government to increase access to MAT for opioid use disorder. New
York State recently enacted legislation prohibiting insurers from requiring
prior authorization for emergency supplies of MAT medications and also
removed prior authorization for Medicaid members seeking MAT for opioid use
disorder, while the federal government increased the maximum number of
patients that MAT-certified providers can treat at one time from 100 to 275
and now permits qualified nurse practitioners and physician assistants to
prescribe MAT drugs.

“ASAM welcomes Attorney General Schneiderman’s agreement with Anthem to
discontinue the requirement of prior authorization requirements to cover
buprenorphine containing medications. We also applaud the agreement for
Empire BCBS to actively work to improve access to effective opioid
treatment with MAT for their network members and to provide evidence for
that improved access. We hope to see other payers following the lead of
Cigna and Anthem on this critical issue,” said Kelly J. Clark, President
Elect of the American Society of Addiction Medicine.

“We applaud Attorney General Schneiderman for continuing to challenge
discriminatory barriers to drug treatment. Preauthorization requirements
for addiction medication are not only discriminatory, but cost lives. It
is critical that all health insurers offer the full range of medications to
treat substance use disorders, without imposing illegal barriers to these
life-saving treatments,” said *Sally Friedman, Legal Director, Legal Action
Center. *

“My son, Michael, was denied treatment he desperately needed,” said Avi
Israel, President and Founder of Save the Michaels of the World. “This
settlement removes the prior authorization obstacle for MAT that too many
families have faced for too long. I thank Attorney General Schneiderman for
his hard work.”

“Many individuals with mental illness also have a co-occurring addiction
disorder. A significant impediment to getting medication—assisted treatment
(MAT) for opioid use disorder in the pre authorization challenges that many
individuals face. We applaud Attorney General Schneiderman and his staff
for advocating strongly for individuals with behavioral health needs, by
both working to highlight and eliminate these pre-authorization practices,”
said Glenn Liebman, CEO, Mental Health Association in New York State.

Richard D. Blondell, MD, Professor and Vice Chair for Addiction Medicine
in the Department of Family Medicine, University at Buffalo said, “this
practice created a huge burden on the staff of medical offices and was
associated with a delay in the treatment of patients. When a person who has
an opioid use disorder decides to seek help, there is typically a small
window of opportunity to engage that individual in effective treatment;
waiting for days to treat this condition represents an unnecessary risk
that can be deadly for some.”

Kevin Jones, the Executive Director of the Heroin Epidemic Action League
(HEAL) of Auburn said, “this agreement with the Attorney General is a
great step forward in the battle against opioid abuse. When an addict
finally reaches the point where they are ready to do something about their
problem, there is only a short window of time to get them treatment.
Without immediate medical assistance, many return back to the streets, and
it may never cross their mind again to seek help. People die every day from
using drugs, while waiting for help. That was the case with my step
daughter. This agreement will save thousands of lives.

“The Long Island Council on Alcoholism and Drug Dependence (LICADD) wishes
to convey our debt of gratitude to NYS Attorney General Eric Schneiderman
who continues to advocate for the rights of substance users to access
evidence-based treatment modalities void of stigma and inequities often
displayed in the excluding policies of insurance companies. In times of
great crisis, there emerges individuals with a great sense of duty and
responsibility. AG Schneiderman has demonstrated his willingness to engage
in effective action in challenging these inequities demonstrated by
insurance companies to insure all New Yorkers, and their families,
afflicted with the disease of substance use disorders have equal access to
the quality care and treatment afforded to individuals living with other
diseases and conditions. On behalf of the thousands of individuals and
families we serve at LICADD, thank you Mr. Attorney General,” said Steve
Chassman, LCSW, CASAC- LICADD Executive Director.

“Medication-assisted treatment can provide a path to recovery for those
struggling with addiction,” said *Jennifer Faringer, M.S.Ed., CPP, Director
of the National Council on Alcoholism and Drug Dependence-Rochester Area
(NCADD-RA).* “The Monroe County Opioid Task Force is focused on eliminating
barriers to treatment, and Attorney General Schneiderman’s continued push
to end prior authorizations for MAT is crucial to this effort.”

Consumers with questions or concerns about this settlement or other health
care matters may call the Attorney General’s Health Care Bureau Helpline at
1-800-428-9071.

Read the agreement with Anthem.

The investigation of this matter was conducted by Assistant Attorneys
General Brant Campbell and Michael D. Reisman, of the Attorney General’s
Health Care Bureau, which is led by Bureau Chief Lisa Landau. The Health
Care Bureau is a part of the Social Justice Division, led by Executive
Deputy Attorney General for Social Justice Alvin Bragg.

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