The governor's plan takes aim at prior authorization from insurers and seeks a prescription cap of a 5-day supply, which would be stricter than the revamped CDC guidelines.
New Jersey Governor Chris Christie on Tuesday proposed capping opioid prescriptions at 5 days and compelling health insurers to fund drug rehabilitation without the “runaround,” in an effort to combat an epidemic that claimed 1600 lives in the Garden State in 2015.
Details of Christie’s plans were still emerging Wednesday, but his intent during the annual State of the State message was clear: while low-income persons with addiction can gain access to care through Medicaid, the governor said, middle-class families with private coverage often struggle to get insurers to pay for help.
He called on the legislature to pass a law that would, “mandate that no citizen with health insurance can be denied coverage for the first 6 months of inpatient or outpatient drug rehabilitation treatment.”
“Rather than support, compassion and coverage,” Christie said families “are met too often by questioning, red tape, and denials by insurers who happily take their premiums at the same time.” He called for an end to “preapprovals,” and “medical necessity reviews” by “bureaucrats.”
“Let’s end the insurance company runaround,” he said.
Christie vowed to work with the nominee to lead CMS, Seema Verma, to remove roadblocks to care. “Eligibility for drug abuse treatment should not be determined by how many beds are in the facility where you seek treatment.”
While Christie took harshest aim at insurers, pharmaceutical manufacturers—a dominant industry in the state—were not completely off the hook. The governor called on his attorney general to investigate relationships between drug companies and prescribing physicians, “if necessary.”
His most far-reaching idea may be a proposed cap limiting opioid prescriptions to a 5-day supply, which would be achieved through an emergency rule change. This would appear to exceed the CDC guideline issued in March 2016, which states that for acute pain, “3 days or less will often be sufficient; more than 7 days will rarely be needed.” The final call rests with the physician.
Other states have recently implemented a 7-day prescription cap, but New Jersey appears to be the first state to try a 5-day limit.
The CDC guideline targeted primary care physicians, after the agency found that in 2012, healthcare providers wrote 259 million opioid prescriptions—a statistic Christie quoted—which is enough for every adult to have a bottle of pills. However, the CDC guideline specifically excluded opioids prescribed in cancer care. It was not clear Wednesday how broad Christie’s rule change would be.
The governor’s interest in the opioid crisis is not new. Christie was at his most effective during the 2016 presidential campaign when he talked about the need to treat addiction as a disease, not a moral failure. He repeated that call Tuesday, along with the story of his law school classmate, who died of opioid addiction that began with prescription pain killers.
“He lost his job. He lost his license to drive. He lost his marriage. He lost the right see his children,” the governor said. Three years ago, Christie and his wife got the call he’d been dreading. “Our friend was dead, alone in a motel room with an empty bottle of Percocet and an empty quarter of vodka.”
However, Christie’s stance on insurers represents an about-face from his 2009 campaign and from most Republicans, who typically oppose mandates of any kind. When he first ran for governor, he called for allowing insurers to sell “mandate free” policies with limited benefits. That was before passage of the Affordable Care Act.
Tom Wilson, director of Public Affairs for the state’s largest insurer, Horizon Blue Cross Blue Shield of New Jersey, said the governor “deserves credit for shining a spotlight on the broad array of factors that have contributed to New Jerseys’ opioid crisis." Wilson pointed out a list of examples of Horizon’s efforts in this area and pledged willingness to work with Christie and the legislature on solutions. Wilson’s statement did not directly address the mandate.
An e-mail to Christie’s spokesman to clarify whether the proposed 5-day prescription cap extends to cancer care did not bring an immediate response.