A Senate bill that aimed to make it easier to get substance abuse treatment in Montana is likely dead. The Senate adjourned Wednesday a few days before Saturday’s deadline to move bills on to the House.
Doctors groups, including the Montana and American Medical Associations, say that now, people who need help may have to wait two years for the next legislative session to cut through what they say is red tape keeping Montanans from accessing recovery options like medication-assisted treatment.
Robert Sherrick is a board-certified addiction specialist from Kalispell.
"Unfortunately in many places in Montana it is much easier to get heroin than it is to get a federally FDA-approved medication to treat opioid addiction," Sherrick says.
Research shows that medications like methadone and buprenorphine can help people wean themselves off opioids, and prevent overdoses, when used alongside counseling and behavioural therapy.
On Monday Dr. Sherrick testified in favor of Senate Bill 280, sponsored by Republican State Senator Al Olszewski. It requires Montana insurance companies to cover medication-assisted treatment for addiction.
"This is not controversial in the field of addiction medicine," Sherrick said.
The bill also proposed to prevent insurance companies from limiting coverage of medication-assisted treatment in any way, like requiring prior authorization or step therapy that could delay treatment.
"When someone presents with an opioid addiction and they want treatment, we need to get that treatment to them right away," said Sherrick. "And it can’t wait. It shouldn’t wait for some sort of onerous process for the insurance companies to decide whether they’re going to pay for it or not."
Those in favor of the bill say it’s part of a national trend as state lawmakers and insurers work together to tackle America’s opioid crisis.
In Montana, drug overdoses account for nearly 250 deaths each year, and 4,000 adults with substance use disorders are unable to get treatment they’re actively seeking, according to a 2017 report.
But insurance companies in Montana said the bill Olszewski brought wouldn’t work.
"As written, this bill is borderline unworkable and exceedingly expensive," said Jennifer Hensley, with PacificSource Health Plans.
Hensley, along with representatives of Blue Cross Blue Shield and Montana Health CO-OP testified Monday that while they want to work with the state to address drug addiction, SB 280 has too many issues.
Some of the points that insurers balked at in the 25 page bill included a requirement to pay for treatments at facilities that aren’t in their networks, and to do so at the same rate as for in-network clinics.
"We often get requests for in-patient treatment for facilities, like, in Malibu. This clause in the bill would not allow us to steer anyone toward an actual qualified, credentialed facility," said Hensley.
Bruce Spencer, a lobbyist for Montana Health CO-OP, said, "these basically say that an insurance company has to indemnify and pay the out-of-network provider everything they want; and it turns the entire network system on its head.”
The fight over who has to pay for addiction treatment, and how much, is not unique to Montana.
Barbara McAneny is the President of the American Medical Association, which advocates for eliminating prior authorizations for medication-assisted treatment across the country.
She says other states that have done so have seen decreased emergency department costs related to overdoses, and decreases in diseases and infections related to drug use, like HIV and hepatitis.
In Montana, from 2010 to 2014, the total charges for ER and substance-abuse related hospital visits totaled $796 million, according to a Department of Justice report.
According to McAneny, "It may cost the insurance companies a little bit more in their pharmaceutical outcome bill, but it will save them money through the emergency department.”
McAneny says those savings spread further out into the state in reduced crime and incarceration when addiction treatment is a priority.
With its first hearing less than a week before the deadline for bills to pass from the Senate to the House, it seemed on Monday unlikely that the bill would move on.
The bill’s opponents like Montana Health Co-Op president Richard Miltenberger say that’s not on them, and that the bill’s late introduction made it hard for insurers to work together with lawmakers to shape something passeable.
"It’s the middle of the session," Miltenberger said. "If you want good input, let’s talk about it in the fall, let’s not do this. This is an important issue."
It now appears it will be two years before the state can consider passing a law to ban prior authorizations on medication-assisted treatments.
But state law isn’t the only solution.
In Pennsylvania, a summit between state leaders and insurance companies led to an agreement where all seven major insurers in Pennsylvania and Medicaid would cover medication-assisted treatment without pre-approval, and at low cost.
In New York, investigations by the state’s attorney general led to settlements with two major insurance providers, Cigna and Anthem that ended prior authorization for medication-assisted treatment for their members in the state. Both Cigna and Anthem then implemented the change nationwide.