Abuse-deterrent opioid legislation on hold until next year

Abuse-deterrent opioid legislation on hold until next year

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On Nov. 2, Gov. Tom Wolf signed a handful of opioid-related bills intended to address the heroin and opioid crisis sweeping through the Keystone State. However, one bill that supporters anticipated would prevent some new cases of opioid addiction was not in the pile.

The legislation would have required insurance companies that cover opioid medication to cover abuse-deterrent opioids, a sometimes costly alternative designed to make it harder for patients to snort, crush, smoke or inject the medication.

The bill was widely supported by Gov. Tom Wolf and lawmakers on both sides of the aisle, but it was never brought up for final vote by the Senate in the final voting days of the legislative session.

Some lawmakers blamed the insurance lobby, who cited concerns about the costs of the alternative opioids, or the Pennsylvania Medical Society for rescinding its support because of last minute changes made to the bill bc

“There were a number of concerns raised about different aspects of the bill. Not one thing in particular led to it not being considered, just enough general concerns that it was thought best to wait,” said Jenn Kocher, spokeswoman for the Senate Republican Caucus.

Rep. Gene DiGirolamo, who has been a leader of opioid-related legislation for a number of years, cast some blame on outside lobbying efforts.

“My guess is, and sense is, that probably the insurance federation was very much opposed to it because of the increased costs. And my guess is that’s probably what killed the bill,” said DiGirolamo, R-Bucks.

That is in fact not that case, said Sam Marshall, president of the Insurance Federation of Pennsylvania, although the group did raise concerns about requiring insurers to cover the pricey alternatives. Most already cover ADOs, a reference to abuse-deterrent opioids, he said.

The federation didn’t support the original bill, but threw its support behind the final version of the bill after it was amended to add a requirement that the state Department of Health write mandatory guidelines for doctors who prescribe abuse-deterrent opioids and require doctors to hand out warning information with every opioid prescription, Marshall said.

“You can go buy a candy bar and there’s a warning label on it,” Marshall said. “To not have warnings attached to opioids given what we’ve seen, I just didn’t understand.”

The amendment, sponsored by Sen. Don White, R-Indiana, was unanimously passed by the Senate Appropriations Committee on the eve of the last Senate voting day.

The insurance federation believed the changes were necessary, as patient disclosures would outline the risks associated with abuse-deterrent opioids, which are still very much addictive, and create mandatory guidelines for all providers to follow, Marshall said.

Marshall was confused by the Pennsylvania Medical Society’s opposition to the changes made to the bill, he said, as prescribing guidelines and warning requirements related to minors and emergency rooms will soon be implemented through other legislation that the Medical Society supported and was signed into law by Wolf on Tuesday.

“The measures in that bill that they had concerns about, that’s what other bills were trying to do,” Marshall said. “[The bill] would extend those protections to all patients.”

Gov. Wolf signed a bill that will limit the amount of opioids prescribed in emergency rooms and urgent care centers to a seven day supply without a refill. Another bill the Governor  signed will limit the amount of opioids prescribed to minors and require parents or guardians sign a consent form and discuss the risks of addiction and overdose before opioids are prescribed.

Others pointed fingers at the Pennsylvania Medical Society for pulling its support of the bill after the changes were made, too.

“The reason it failed last week is due to opposition from the Pennsylvania Medical Society over the requirement that doctors hand out information to patients about the dangers of opioids,” said Jeff Sheridan, a spokesman for Gov. Wolf. “Over 3,500 people died from overdoses last year and everyone should be stepping up to do their part to find solutions to fight this crisis.”

“The last minute concerns raised by the Medical Society, as well as concerns over the high costs of [abuse deterrent opioids] delayed a final vote,” said White.

The medical society opposed the mandate put on doctors to distribute the warning information, saying it will interfere with and hurt patient care.

“We thought that [amendment] was interfering with the doctor-patient relationship,” said Charles Cutler, a physician and president of the Pennsylvania Medical Society.

Cutler said it would adversely affect patients whose risk of addiction is low, including patients who are prescribed opioids for extreme pain related to late-stage cancer and elderly patients who have suffered injuries.

“Patients like that need opioids for their pain,” he said. “In that situation, the risk of addiction is virtually nil. So, to frighten a patient with a conversation of addiction and dangers of the drug, when far and away the drug is going to be beneficial, would be counterproductive.”

Most doctors already voluntarily provide their patients with risk disclosures, he said.

The medical society sent a letter to lawmakers on the last voting day scheduled for the Senate, detailing their opposition to the bill.

The society and the state Department of Health have already created recommended guidelines for prescribing opioids and abuse-deterrent opioids, too, Cutler said, addressing the other change made by the amendment.

The group “solidly” supported the bill before the changes were made and would support it if the language was removed, he added.

While the bill wasn’t addressed this session, all parties hope to see a measure addressing abuse-deterrent opioids in some fashion in the future.

“The governor is disappointed that this bi-partisan legislation did not pass and he plans to continue working with both parties in the legislature to get this bill to his desk,” Sheridan said.