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How New MA Law Affects Our Accounts and Members

The misuse of the prescription painkillers known as opioids is a major nationwide health care crisis. On March 14, 2016, Governor Baker signed landmark legislation that addresses this crisis into Massachusetts law. The new law, titled ‘An act relative to substance use, treatment, education and prevention’ has multiple effective dates that are detailed below. This law, which affects insured and ASC 32B accounts, will increase the availability of substance-use treatment, focus on public education, and encourage the use of best practices in prescribing.

Blue Cross Blue Shield of Massachusetts has long been actively working to address the opioid crisis. In 2012, we were the first health plan in Massachusetts to implement a medication safety and education program. As part of this campaign, we have already put in place some patient safety measures similar to those required by the new law. Below, we explain how the law affects our accounts and members, as well as how we are working to improve quality of care and reduce health risks for our members.

Substance Use Evaluations
The legislation requires Emergency Departments to conduct a substance use evaluation within 24 hours for any patient who is experiencing an opiate-related overdose or was administered naloxone. Patients may not be discharged prior to such an evaluation. Effective July 1, 2016, insurance carriers are required to provide coverage for these evaluations without prior authorization. At Blue Cross, we currently provide coverage for an ER evaluation of substance use with no prior authorization when billed by a facility.

Partial Fills of Controlled Substances
As of March 14, 2016, pharmacists must fill a prescription for a schedule II opioid in a smaller amount than indicated by the prescriber, if requested by the patient. The remaining portion of the prescription would be void. Later this year, the Division of Insurance is expected to develop and implement regulations to ensure that there is “no financial penalty for a patient’s choice to receive a lesser quantity.” Blue Cross already accommodates filling a prescription for a lesser quantity of opioids.

Prescription Limits and Other Prescription Changes
All minors, and adults being prescribed opioids for the first time, are limited to a seven-day supply. The law provides exceptions for emergencies, chronic pain management, and pain associated with a cancer diagnosis or palliative care. At Blue Cross, we will have updated our processes to reflect the requirement.

Other Requirements
The Massachusetts Drug Formulary Commission is expected to publish a list of non-opioid drugs that are effective for pain management with less potential for misuse. In addition, medical providers and insurers must update their list of Class B drugs to include Acetyl fentanyl and alphaprodine.

If you have any questions about the new law or our patient safety programs at Blue Cross, please call your account executive.

Blue Cross Blue Shield of Massachusetts

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