Just five weeks after he outlined the initiatives for lawmakers, industry officials, and the public, New Jersey Gov. Chris Christie signed a law Wednesday that he framed as the “nation’s strongest” effort to reform government regulations to reduce access to highly addictive prescription drugs and improve access to recovery programs.
The law – signed less than an hour after it received final legislative approval – codifies two of the governor’s priorities in what has become an increasingly public effort to curb the Garden State’s addiction epidemic that he kicked off with his State of the State Address on January 10.
It would reduce insurance barriers to long-term inpatient and outpatient treatment for substance-use disorders, ensuring patients up to six months of coverage, and create a five-day limit on initial opiate prescriptions for patients with short-term pain, like that caused by an accident or a medical or dental procedure. No other state has such stringent requirements, Christie said.
No impact on prescriptions for patients with chronic pain
The law does not impact prescriptions for patients with chronic pain from cancer or other conditions, or patients in hospice, but the proposal sparked outrage among some physicians’ groups and advocates for pain patients concerned about losing treatment options.
While they failed to convince lawmakers to ease the prescription limit during the expedited legislative review, two Republican lawmakers announced Wednesday afternoon they would introduce separate legislation to change it from the new five-day limit to seven days – a model used in a few states.
The concept of a six-month insurance mandate prompted cost questions for insurance providers, but they worked with sponsors to ensure the law requires a physician to declare the treatment is medically necessary. It also allows for certain plan review after the first 28 days, and at limited intervals if additional treatment is warranted. The coverage applies to both inpatient residential care and outpatient treatments; there would be no additional cost to patients.
Christie signed the bill the day after he joined President Donald Trump for lunch in Washington, at which the governor reportedly stressed the importance of tackling the rising level of substance use disorders nationwide.
‘This is no doubt the strongest law in the country…’
“Lives will no longer be put at risk by layers of needless bureaucracy or due to an overabundance of prescribed opioid pills that get into the hands of children and the vulnerable,” Christie said Wednesday. “This is no doubt the strongest law in the country that will provide critical prevention and treatment measures to combat the rampant, deadly disease of addiction.”
In his State of the State, Christie focused nearly two-thirds of his speech on the issue, making a passionate argument for public awareness of addiction as a disease, not a moral failing. He outlined a number of plans to improve access to lifesaving drugs that can reduce an overdose, expand the availability of recovery housing and sober-living facilities, and better educate pupils from children through high school about the dangers of all drugs, from prescription pills to marijuana to heroin.
Two weeks ago he announced the state would accept proposals from hospitals to expand the number of emergency beds for patients with mental illness, or mental illness and addiction issues. The initiative could add up to 900 spots for inpatient treatment and help address what is often seen as a chronic shortage of space, but it will take at least a year before the beds will be licensed and ready for patients.
The state is now preparing to spend as much as $1 million, and possibly more, on a public awareness campaign related to the dangers of addiction. Three weeks ago, it released a cable-television ad that features Christie promoting the state’s new 24-hour hotline for all addiction-related services. Follow this link to reach the website or call or call 844-ReachNJ (884-732-2465).
Death rate three times the number killed in auto accidents
In 2015, some 28,000 patients received inpatient treatment in New Jersey, but thousands of others were unable to get access to care. Another 1,600 addicts lost their lives to opiate addiction that year – a 22 percent increase over 2014 deaths, Christie said. The death rate is also three times the number killed in automobile accidents in 2015 and four times the number murdered, he said.
Legislation (A3/S3) to codify Christie’s key proposals – the insurance mandate and the prescription limit – was introduced on January 30 by leaders in both houses and received a final vote in the Assembly two weeks later. Sponsors included Senate President Steve Sweeney (D-Gloucester), Senate Health Committee Chairman Joe Vitale (D-Middlesex), Republican Senate Minority Leader Tom Kean Jr. (R-Union) and others; Assembly Speaker Vincent Prieto (D-Hudson), Assembly Minority Leader Jon Bramnick (R-Union), and Assembly Health Committee Chairman Herb Conaway Jr. (D-Burlington.)
Lawmakers from both parties welcomed the bill as a compassionate approach to a growing problem – something many said they have seen first hand, either among friends, family members, or constituents. It was also welcomed by advocates for mental health and addiction providers and their clients, who praised the governor’s advocacy and efforts to reduce the stigma surrounding both diseases.
“This bill demonstrates the administration’s recognition that substance-use disorders are medical illnesses, which, along with mental health disorders, must be treated the same – both clinically, and in attitude – as physical health conditions,” said Debra Wentz, president and CEO of the New Jersey Association of Mental Health and Addiction Agencies.
Vitale, who has long led efforts to reduce the impact of addiction, said the law “will go a long way” toward reducing the supply of prescription painkillers and ensuring many have immediate access to comprehensive addiction treatment. But more work is needed to reduce the levels of addiction and improve options for recovery, he said.
“There is no one-size-fits-all approach when we are dealing with the disease of addiction, and no one bill can possibly address all of the issues that we are faced with as we continue to fight against this public health crisis in New Jersey,” Vitale said. “We will continue our efforts aimed at education, prevention, and treatment of substance abuse.”
In addition to requiring coverage for long-term treatment — when ordered by a physician, psychologist, or psychiatrist — the insurance mandate portion of the new law would force the company to find a location for a new patient within 24 hours, even if it was outside their network or out of state. The company could not challenge the doctor’s determination until at least a month.
The law also calls on state officials to create a process to guide whether a treatment is “medically necessary” and to set up an appeals process to settle any disputes between patients and insurance companies. It also requires quick decisions by the insurance company so patients aren’t left waiting for a determination.
Christie framed the insurance mandate as an effort to help the middle class, adding that because of state insurance regulations it would only apply to a limited number of plans sold in the state, limiting its reach. In fact, it will cover maybe 30 percent of insured residents, including government workers, teachers and those who buy private plans as individuals and small businesses. It does not to apply to the nearly 1.8 million residents on Medicaid or the nearly 50 percent of insured residents who have policies provided by self-insured companies, which are governed by federal law.