New Jersey Poised to Pass Opioid Treatment Mandate—and Health Plans Are Part of the Solution

The legislature is expected to give final passage to the nation's strictest treatment mandates and a 5-day cap on the initial opioid prescription. Governor Chris Christie's plan has met little resistance, even though the cost is unknown.
Published Online: February 14, 2017
Mary Caffrey and Christina Mattina
This week, New Jersey Governor Chris Christie will likely sign into law the centerpiece of his plan to fight the state’s opioid crisis, giving teeth to a crusade that was a high point of his presidential campaign. So far, a snowstorm has been the only obstacle to the far-reaching bill, which features:

·         the nation’s strictest mandates for getting patients into treatment
·         a 5-day cap on the first opioid prescription—the tightest limit in the United States
·         opioid education requirements for every licensed healthcare professional who prescribes them, from physicians to midwives.

After being snowed out last week, the General Assembly will vote Wednesday, February 15, on S3/A3, a bill that has already cleared the Senate 33-0. Christie called for the nation’s first 6-month treatment mandate in his State of the State address January 10, 2017, and has met little resistance, even though no one knows how the plan will affect premiums. The biggest controversy, in fact, isn’t Christie’s plan, but his appearance in TV ads encouraging addicts to seek care.

A rising death toll has fueled united, bipartisan support, and Christie has already signed a bill that requires health professionals to educate youth about the risk of addiction before prescribing drugs. In all, more than 10 different bills addressed aspects of treatment, prevention, and recovery, but S3/A3 is the key, designed to end the “runaround” the governor said too many addicts and families experience. Once signed, the law takes effect in 90 days.

New Jersey’s health plans, rather than fight Christie, opted for tweaks that will give them more say in where care occurs. According to testimony, the NJ Association of Health Plans (NJAHP) pointedly did not oppose the bill, but sought to keep addiction services within the umbrella of “accountable care,” and to not assume inpatient care is best. On Friday, the CEO of the largest plan, Horizon Blue Cross Blue Shield of New Jersey, published a guest column that did not explicitly endorse or oppose the bill, but supported the handling of addiction as “a disease—not a behavior, choice or moral failure.”

“Mandating that insurance policies include a specific benefit requires striking the right balance between affordability and coverage,” Horizon’s CEO, Robert A. Marino, wrote. “I applaud the governor and legislative leaders for working to strike the right balance, engaging all parties to face the problem and advancing a comprehensive solution.”

Prescription opioids and their chemical cousins, heroin and fentanyl, have New Jersey in their grip: in December, the state medical examiner reported there were 1587 drug overdose deaths in 2015—a 21% jump from the prior year—and heroin deaths reached the highest ever recorded, at 918. The CDC has listed New Jersey as 1 of 19 states with “statistically significant” increases in drug overdose deaths.

But the statewide numbers don’t tell the whole story. Pockets of New Jersey—especially Ocean County, which is home to a sizable senior population—are so devastated that death tolls rival those in all of New Hampshire and Kentucky, which have the second- and third-highest death rates from opioids per 100,000 population. Ocean County recorded 205 opioid-related deaths in 2016, which means Ocean County has an unadjusted rate of 34.8 deaths per 100,000 population, using US Census figures.

VIDEO: Prosecutor Joseph D. Coronato Explains How Naloxone Programs Do More Than Stop Overdoses

Ocean County Prosecutor Joseph D. Coronato, who has pioneered strategies like equipping local police with Narcan (naloxone) and using “recovery coaches” in the emergency department, told The American Journal of Managed Care® (AJMC®) that Christie’s plan targets a critical need: getting addicts who are saved from an overdose into treatment without delay. The “coaches,” recovered addicts who counsel overdose patients right after they have been spared, can be highly effective, but only if the path to treatment is uninterrupted. “If you don’t get them when the tear drops are warm, that’s a lost opportunity,” he said in a video interview with AJMC®.

He sees the 6-month treatment requirement—more so than the 5-day pill limit—as the “game changer” of the governor’s plan, but emphasized that continuous support from a mentor is key to preventing relapses after an addict leaves the treatment facility.

He also discussed how the Narcan program does more than just stop overdoses; it has actually given the police officers a more personal look at the effects of addiction, changing their perceptions of what a drug addict looks like.

“It’s somebody’s son, it’s somebody’s daughter, it’s someone’s loved one,” he told AJMC®, “and I think the police officers now can relate better to that.”



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