Governor’s Action on MAT Bills
January 2, 2020
On December 31, the Governor signed into law A2904 Quart, Same as S4808 Weprin that prohibits prior authorization for certain medications used in the treatment of substance use disorders in most commercial insurance policies.
On January 1, Governor Cuomo vetoed S05935A, Harckham, Same as A07246-B, Biaggi that would have prohibited Prior Authorization (PA) for certain SUD medications (MAT) for New Yorkers enrolled in Medicaid.
The NYS Council is deeply disappointed with the Governor’s decision to veto the Medicaid bill. It was clear from the outset the Administration was concerned that lifting PA requirements for certain SUD meds in Medicaid would be expensive. But the human costs associated with delayed access to MAT are far greater. The disparity that now exists as a result of these actions must be addressed.
Regarding the Governor’s veto of the bill that would have lifted Prior Authorization of certain SUD medications in the Medicaid Program, we knew the Administration had been struggling to ensure all manufacturers of certain frequently prescribed MAT medications were willing to participate in New York’s Drug Rebate Program. According to the Veto Message (below) one pharmaceutical manufacturer refused to play ball.
At the end of the day we hope you will agree that decisions about which medications are prescribed to treat mental health or substance use disorders should ultimately be based on what is best for the individual requiring the medication.
Excerpted from Veto message:
“…However, in reality, this bill would provide a statutorily-authorized unfair competitive advantage to one pharmaceutical manufacturer in particular. This manufacturer fails to offer sufficient competitive pricing to be included on the preferred drug list or on many managed care organization formularies, and in lobbying for this legislation to eliminate prior authorization requirements, requires Medicaid plans and the State to pay whatever price this manufacturer charges. Indeed, its website touts its success in obtaining “legislative changes in some states to force publicly financed payers to reimburse all products.” There are no clinical differences or benefits among the available drugs in the opioid use disorder (OUD) class. Enactment of this law, therefore, does nothing to improve access, rather it only increases the bottom line of one particular manufacturer costing the State approximately $30 million..”
“…Further, in the Executive Budget I will propose to create a single preferred-drug list for MAT that will be available for all Medicaid recipients, without allowing a manufacturer to name its price, requiring the State to pay…”
VETO MESSAGE – No. 292
TO THE SENATE:
I am returning herewith, without my approval, the following bill:
Senate Bill Number 5935-A, entitled:
“AN ACT to amend the social services law and the public health law,
in relation to medication for the treatment of substance use
disorders”
NOT APPROVED
The opioid epidemic is an insidious public health crisis that contin-
ues to ravage communities across New York. I have taken aggressive
action to combat this epidemic, and we are seeing results with the first
reduction in opioid overdose deaths in 10 years. However, there is far
more to be done, and expanding and ensuring meaningful access to medica-
tion assisted treatment is a critical step to eliminating the opioid
epidemic.
This bill would ostensibly eliminate the need for prior authorization
from a Medicaid managed care plan when a patient needs to access medica-
tion assisted treatment (MAT). However, in reality, this bill would
provide a statutorily-authorized unfair competitive advantage to one
pharmaceutical manufacturer in particular. This manufacturer fails to
offer sufficient competitive pricing to be included on the preferred
drug list or on many managed care organization formularies, and in
lobbying for this legislation to eliminate prior authorization require-
ments, requires Medicaid plans and the State to pay whatever price this
manufacturer charges. Indeed, its website touts its success in obtaining
“legislative changes in some states to force publicly financed payers to
reimburse all products.” There are no clinical differences or benefits
among the available drugs in the opioid use disorder (OUD) class. Enact-
ment of this law, therefore, does nothing to improve access, rather it
only increases the bottom line of one particular manufacturer costing
the State approximately $30 million.
The publicly available statements of the manufacturer are prima facie
evidence of the true nature of this bill. Further, we have already
implemented many laws and policies to ensure patients have access to MAT
– there is no prior authorization for preferred or formulary versions of
buprenorphine and injectable naltrexone. Even if a drug is not
preferred, a patient is guaranteed a 5-day dosage when they present a
prescription while prior authorization takes place, which must be within
24 hours of receipt of the requested information. Because we are facing
a structural deficit in Medicaid, the $30 million cost is untenable when
it comes at no clinical benefit to any New Yorker.
This bill also prohibits prior authorization for naltrexone, an
injectable drug that is also a single brand name drug. Since current law
requires one MAT drug per class be on the preferred drug list and
managed care plan formularies, naltrexone is already exempt from prior
authorization requirements. However, if additional drugs from this class
come to market, at that point, this provision provides price protection
for that brand name drug.
This bill also eliminates any prior authorization for methadone.
Diversion is a particular concern with methadone, which can cause
significant harm to the people the drugs are intended to help. This is
why methadone, when used to treat OUD, can only be administered or
dispensed at an OASAS Article 32 clinic for which the State has already
removed any prior authorization requirements. Methadone’s use at such a
facility does not result in diversion, eliminating safety concerns.
We offered many potential compromises to the legislature on this bill
to make sure access could be guaranteed while not resulting in a give-
away to manufacturers, and to ensure that there were not unintended
consequences. Every effort at a compromise was rejected.
Thanks to many initiatives spearheaded by my administration more New
Yorkers than ever have access to MAT for OUD. This year we aggressively
expanded access to MAT both by increasing the number of medical profes-
sionals who are designated to prescribe and by expanding the number of
settings in which MAT can be prescribed. Further, in the Executive Budg-
et I will propose to create a single preferred-drug list for MAT that
will be available for all Medicaid recipients, without allowing a
manufacturer to name its price, requiring the State to pay.
For the foregoing reasons, I cannot support this legislation as writ-
ten. This bill is a giveaway to manufacturers, risks the important
progress we have made to combat opioid use disorder, and does not have
any clinically beneficial impact for New Yorkers.
The bill is disapproved. (signed) ANDREW M. CUOMO