RE: A.2904 (Quart)—An act to amend the insurance law, in relation to prohibiting certain insurance policies from requiring prior authorization for certain medications used in the treatment of substance use disorders; and to repeal certain provisions of such law relating thereto.

This legislation, A2904, seeks to prohibit health plans from requiring prior authorization (PA) for medication assisted treatment (MAT) for heroin/opioid addiction. New York’s health plans support MAT, but, while this bill is well intended, the New York Health Plan Association (HPA) opposes the legislation because it includes prohibition of PA for long acting naltrexone, otherwise known as Vivitrol.

While buprenorphine and methadone can be used as the frontline treatment for heroin/opioid addiction, the same cannot be said for Vivitrol. In order to initiate treatment with Vivitrol, the individual must go through complete detoxification and have no opiates in their system, which includes buprenorphine and methadone. During the period in which the individual is undergoing the complete detoxification from all opiates in their system, between 7 and 14 days, there is more than adequate time for the treatment provider to comply with the plan PA requirements and determine if Vivtrol is the appropriate MAT for the individual.

In addition, Vivitrol is not appropriate for all individuals suffering with heroin/opioid addiction. On June 11, 2017, the New York Times published a story, “Seizing on Opioid Crisis, a Drug Maker Lobbies Hard for Its Product,” which detailed serious concerns regarding the evidence supporting the use of Vivitrol. According to the article Vivitrol’s clinical trial was conducted in Russia, where regulations on clinical trials are lower in comparison to the United States. The clinical trial was against a placebo, rather than buprenorphine or methadone.

Dr. David Fiellin, an addiction specialist at Yale, stated “Due to their established efficacy, methadone and buprenorphine are on the World Health Organization’s list of essential medications….Naltexone and Vivitrol are not.” Individuals that use Vivitrol to control their addiction are at a greater risk of overdose if they begin using heroin/opioids again.

For these reasons, HPA opposes A.2904.