The generic prescription pain medication buprenorphine is seen in a pharmacy on February 4, 2014, in Boca Raton, Florida. (Joe Raedle/Getty Images)
With a bipartisan bill that Gov. Jared Polis signed into law Monday, state legislators forced state-regulated insurance plans to provide optional alternatives to prescription opioids. The law is aimed at preventing addiction and overdose.
Polis, however, expressed concern that the legislation — along with recent and future laws that mandate coverage for specific health care — could lead to higher costs for consumers. In a Monday statement to lawmakers, the governor called for a “uniform, evidence based process” to determine the costs and benefits of future health insurance mandates.
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“Consumers deserve our informed consideration of the costs as well as the benefits of adding new coverage mandates,” Polis wrote, “and it is my strong hope that the legislature takes up legislation next session that will ensure that this analysis occurs.”
The new law, House Bill 21-1276, requires private, state-regulated health insurance plans to help cover alternatives to opioids like oxycodone and morphine. That might include a prescription for an “atypical” opioid such as buprenorphine, or up to six visits to a physical therapist, a chiropractor or an acupuncture provider. The copay for alternative treatment can’t exceed a copay the insurer would charge for a primary care visit that’s not an annual check-up.
Sponsors of HB-1276 included Reps. Chris Kennedy, a Lakewood Democrat, and Leslie Herod, a Denver Democrat, along with Sens. Brittany Pettersen, a Democrat from Lakewood, and Kevin Priola, a Republican from Brighton.
“I appreciate Governor Polis’ focus on reducing the high cost of health care and I generally support the idea of a standardized process for evaluating proposed insurance mandates,” Kennedy said via email. “Where the Governor and I differ is that I believe there are instances in which increasing access to a particular health service justifies a potential premium increase. In HB1276, for example, better coverage of safer alternatives to opioids will reduce the number of Coloradans who develop an opioid dependency and will ultimately save lives.”
In 2019 — the most recent year for which data is available — 1,062 people died from a drug overdose in Colorado, according to the Colorado Department of Public Health and Environment. That represented a 9% increase from 2018 and a 4.9% increase from 2017.
About half of the deaths were caused by prescription opioids or heroin. The number of fatal overdoses from those substances increased 12% from 2018 and 9.2% from 2017.
“While there’s a chance that increased utilization of physical therapy could lead to a slight increase in insurance premiums in the short term, I believe the long term impact on saving lives, as well as saving money from emergency room visits, justifies the short term cost,” Kennedy said. “I am grateful that Governor Polis’ team worked with me to add provisions to the bill that made him comfortable with signing it into law.”
Based on a third-party analysis, the Colorado Division of Insurance found that the alternatives to opioid treatment included in HB-1276 would increase premiums on state-regulated insurance plans by 0.1%, or around $0.45 per person per month, according to the governor’s signing statement.
Another section of HB-1276 concerns Colorado’s Prescription Drug Monitoring Program, or PDMP, which recently came under scrutiny by state auditors.
In a June report that analyzed PDMP data, the Office of the State Auditor reported that out of 1.4 million Colorado patients with opioid prescriptions in 2018 and 2019, nearly 8,700 patients each received prescriptions from 10 or more medical providers, a practice commonly referred to as “doctor shopping.” Approximately 1,200 of the patients each received opioid prescriptions from 15 or more medical providers.
HB-1276 requires medical providers to check the PDMP more frequently to identify whether a patient might be doctor shopping to get prescriptions for opioids or benzodiazepines from multiple providers. Benzodiazepines include medications like Valium or Xanax that are commonly used to treat anxiety.
Last year, Polis vetoed a similar bill. Like HB-1276, House Bill 20-1085 would have mandated that private health insurers provide certain coverage related to opioid alternatives and that providers check the PDMP more often.
“Given our current fiscal situation, Colorado is sadly not in a position to absorb increased costs of private health insurance,” Polis wrote in a veto letter dated July 2, 2020. The governor expressed concern that if the federal government ruled the new insurance mandate nonessential, federal law would require the state to pay for it — to the tune of millions.
But Polis added, “I agree with the underlying premise of the legislation: we must do more to elevate alternative pain management treatments to reduce the use of opioids.”
This year’s version contains a provision that should protect the state’s budget from having to cover the new mandates. Under this provision of HB-1276, the benefit mandate will only take effect if the federal Department of Health and Human Services confirms that the state won’t have to pay for it.
Besides mandating alternatives to opioid treatment and increasing PDMP checks, HB-1276:
• Permanently extends opioid prescribing limits, which prevent a provider from prescribing more than seven days’ worth of opioids to a person for whom the provider hasn’t written a opioid prescription in the last year
• Requires regulatory boards to develop and implement rules similarly limiting benzodiazepine prescriptions
• Allows medical examiners and coroners to query the PDMP when conducting a death investigation
“Preventing substance use disorders will save lives and help our communities recover from the pandemic,” Herod said in a Monday statement after the bill signing. “This has been a deadly year for drug overdoses in our state. Coloradans need more options to reduce opioid use when other treatments may help.”
Still pending is a separate bill that would require insurance plans to cover an annual mental wellness exam in addition to a yearly physical check-up. Similar legislation died in 2020 under threat of veto by Polis, but this year, according to the Democratic sponsor — Rep. Dafna Michaelson Jenet of Commerce City — the governor is expected to sign House Bill 21-1068.
Last year, Polis’ veto warning came in the form of an April 2020 statement he released after signing House Bill 20-1158, which mandated coverage of infertility treatments.
In the statement, Polis said he signed House Bill 20-1158 “for the compelling reasons articulated by the sponsors and advocates for this bill,” which included helping women who are unable to get pregnant but couldn’t afford treatment that would help.
But Polis added that he would only sign bills with new insurance mandates after 2020 if the bills included language protecting the state’s general fund from “unanticipated costs,” and only if lawmakers provided “substantial and documented” evidence including an actuarial analysis to show the legislation would save people money on health care.
The insurance industry estimates that HB-1068 would increase premiums by 1%, Michaelson Jenet told Newsline in May — calling that “not a significant amount.” In the long run, she added, preventive mental health care would save people money.
“We worked very closely with the governor and the commissioner of insurance ever since it didn’t make it past the finish line last year,” Michaelson Jenet said. “This bill strikes that compromise.”
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