Polis signs substance use prevention bill but warns against future health insurance mandates


Generic prescription pain medication buprenorphine is seen at a drugstore on February 4, 2014, in Boca Raton, Florida. (Joe Raedle / Getty Images)

With a bipartisan bill that Governor Jared Polis signed into law on Monday, state lawmakers forced state-regulated insurance plans to offer optional alternatives to prescription opioids. The law aims to prevent drug addiction and overdose.

Polis, however, expressed concern that the legislation – as well as recent and future laws that mandate coverage for specific health care – could result in higher costs for consumers. In a statement to lawmakers on Monday, the governor called for a “consistent, evidence-based process” for determining the costs and benefits of future health insurance mandates.

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“Consumers deserve our informed examination of the costs as well as the benefits of adding new hedging mandates,” Polis wrote, “and I very much hope that the legislature will pass legislation in the next session that will ensure that this analysis is carried out. produce. “

The new law, Bill 21-1276, requires private and state-regulated health insurance plans to help cover opioid alternatives like oxycodone and morphine. This can include a prescription for an “atypical” opioid such as buprenorphine, or up to six visits to a physical therapist, chiropractor, or acupuncture provider. The co-payment for alternative treatment cannot exceed a co-payment that the insurer would charge for a primary care visit that is not an annual check-up.

Sponsors of HB-1276 included Reps Chris Kennedy, a Democrat from Lakewood, and Leslie Herod, a Democrat from Denver, as well as Sens. Brittany Pettersen, a Democrat from Lakewood, and Kevin Priola, a Republican from Brighton.

“I appreciate Governor Polis’ emphasis on reducing the high cost of health care and generally support the idea of ​​a standardized process for evaluating proposed insurance mandates,” Kennedy said via email. . “When the governor and I disagree, it is because I think there are cases in which increased access to a particular health service justifies a potential increase in premiums. In HB1276, for example, better coverage of safer opioid alternatives will reduce the number of Coloradans who become addicted to opioids and ultimately save lives.

In 2019, the most recent year for which data is available, 1,062 people died of drug overdoses in Colorado, according to the Colorado Department of Public Health and Environment. This represents an increase of 9% compared to 2018 and 4.9% compared to 2017.

About half of the deaths were caused by prescription opioids or heroin. The number of fatal overdoses due to these substances increased by 12% compared to 2018 and by 9.2% compared to 2017.

“While it is possible that increased use of physical therapy could lead to a slight increase in insurance premiums in the short term, I believe the long term impact on saving lives, as well as cost savings. during emergency room visits, justifies the short-term cost. “Kennedy said.” I am grateful that Governor Polis’ team worked with me to add provisions to the bill that made him feel comfortable signing it.

Based on a third-party analysis, the Colorado Division of Insurance found that the opioid treatment alternatives included in HB-1276 would increase premiums for state-regulated insurance plans by 0.1%, or about 0. , $ 45 per person per month, according to the governor. signature declaration.

Another section of HB-1276 relates to the Colorado Prescription Drug Monitoring Program, or PDMP, which has recently come under intense scrutiny by state auditors.

In a June report analyzing data from the PDMP, the State Auditor’s Office reported that out of 1.4 million Colorado patients who received opioid prescriptions in 2018 and 2019, nearly 8,700 patients each had opioid prescriptions. received prescriptions from 10 or more medical providers, a practice commonly referred to as “physician buying”. About 1,200 of the patients each received opioid prescriptions from 15 or more health care providers.

HB-1276 requires healthcare providers to check the PDMP more frequently to determine if a patient could purchase a physician to obtain prescriptions for opioids or benzodiazepines from multiple providers. Benzodiazepines include drugs like Valium or Xanax that are commonly used to treat anxiety.

Last year Polis vetoed a similar bill. Like HB-1276, House Bill 20-1085 reportedly required private health insurers to provide some coverage related to opioid alternatives and providers to check PDMP more often.

“With our current fiscal situation, Colorado is unfortunately unable to absorb the increased costs of private health insurance,” Polis wrote in a statement. veto letter dated July 2, 2020. The governor expressed concern that if the federal government deemed the new insurance mandate non-essential, federal law would require the state to pay for it – to the tune of millions.

But Polis added, “I agree with the underlying premise of the legislation: we need to do more to elevate alternative pain management treatments to reduce opioid use.

This year’s version contains a provision that should protect the state budget from having to cover new mandates. Under this provision of HB-1276, the benefit mandate will only take effect if the federal Department of Health and Human Services confirms that the state will not have to pay for it.

In addition to imposing alternatives to opioid treatment and increasing PDMP controls, HB-1276:

• Permanently expands opioid prescribing limits, preventing a provider from prescribing more than seven days of opioids to someone for whom the provider has not written an opioid prescription in the last year
• Requires regulators to develop and implement rules similarly restricting prescriptions for benzodiazepines
• Allows forensic pathologists and coroners to question the PDMP when conducting a death investigation

“Preventing substance use disorders will save lives and help our communities recover from the pandemic,” Herod said in a statement Monday after the bill was signed. “It has been a deadly year for drug overdoses in our state. Colorado residents need more options for reducing opioid use when other treatments can help.

Still pending, a separate bill would require insurance plans to cover an annual mental wellness exam in addition to an annual physical exam. Similar legislation died in 2020 under threat of a Polis veto, but this year, according to the Democratic sponsor – Commerce City Representative Dafna Michaelson Jenet – the governor is expected to sign Bill 21-1068.

Last year, Polis’ veto warning came in the form of an April 2020 statement he released after signing House Bill 20-1158, which made coverage for infertility treatments compulsory.

In the statement, Polis said he signed Bill 20-1158 “for the compelling reasons put forward by the sponsors and supporters of this bill,” which included helping women who cannot get pregnant but who cannot afford treatment that would help them.

But Polis added that he would only sign bills with new insurance mandates after 2020 if the bills included language protecting the state’s general fund from “unforeseen costs” and only if lawmakers provided “substantial and documented” evidence including an actuarial analysis to show the legislation would save people money on health care.

The insurance industry estimates that HB-1068 would increase premiums by 1%, Michaelson Jenet told Newsline in May, calling it “an insignificant amount.” In the long run, she added, preventive mental health care would save people money.

“We have worked closely with the governor and the insurance commissioner since he failed to cross the finish line last year,” said Michaelson Jenet. “This bill achieves that compromise.”

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