It is hoped to be a happier new year for Empire State residents suffering from opioid abuse. In a landmark legislative package that took effect January 1st of this year, health insurance plans will now be required to cover treatment services to New Yorkers suffering opioid addiction. In a state plagued by the effects of opioids and heroin, whose overdose death rates are far outpacing nearly every state in the union, legislators are hopeful those grappling with the effects of these drugs can finally gain access to the help they need in overcoming addiction.

The Plan to Expand Access to Opioid Addiction Care

Signed into law by Governor Andrew M. Cuomo, the reforms are expected to remove burdensome treatment access barriers, help expand prevention strategies from within communities, and limit opioid over-prescriptions statewide. What is the governor’s Heroin and Opioid Task Force plan to stamp out abuse?

  • Insurance-Related Protections
    • Insurance pre-authorization no longer required for immediate access to inpatient care and (emergency) drug treatment medications when needed.
    • Utilization review (insurance) cannot become involved until after 14 days of uninterrupted treatment.
    • Insurers must use objective, state-approved criteria when making coverage determinations.
    • Opioid-reversal medication coverage is mandated.
    • Requirements apply to small, large group, and individual plans regulated by the DFS.
  • Addiction Treatment Services Enhancements
    • Individuals incapacitated by drugs can now receive 72, not 48 hours of emergency treatment and evaluation.
    • Hospitals are now required to provide follow-up service at discharge, connecting at-risk patients with nearby treatment options for continuous care.
    • Trained professionals no longer risk licensure when administering naloxone in emergencies.
    • Wraparound services (legal, support, transportation, childcare) have been expanded to support long-term recovery.
  • Community Prevention Strategies
    • Prescription limits reduced from 30 to 7 day supply maximum (with exceptions).
    • Required continuing education for all physicians/prescribers on addiction/pain management.
    • Pharmacists must provide materials on addiction risks and nearby treatment services.
    • Opioid overdoses and overdose medication use must be reported quarterly.

Ensuring Appropriate Treatment Options For Opioid Addiction 

Much like the measures put forth by the state of New York, ANS Solutions’ Pharmacotherapy Review Program strives to uphold appropriate treatment options for patients, offering protection against opioid dangers with a three-stage approach to injury recovery that far-surpasses drug utilization review. Comprehensive and effective, it both protects against unnecessary expenses and safeguards patient treatment outcomes. Utilizing personal, face-to-face communication and integrative case-management methods, over-prescription of dangerous narcotics and potentially deadly drug-to-drug interactions commonly experienced with multiple prescribers can be prevented, success achieved with evidence-based treatment protocols and cemented by written proposal to achieve maximum results.

Don’t stand on the sidelines of the epidemic. Take part in the solution. Reinvent the way you handle claims with the help of ANS Solutions today.