PROVIDENCE – The R.I. Senate on May 3 approved legislation sponsored by Sen. Lori Urso, D-Pawtucket, that would prohibit health insurance companies from requiring or conducting a mid-treatment utilization review of prescription medications used to treat alcohol or opioid use disorder, provided the medication contains methadone, buprenorphine or naltrexone, or was approved by the Food and Drug Administration to treat opioid withdrawal symptoms.
“Providers have been telling us for years that both prospective and concurrent reviews are unnecessary administrative burdens that disrupt and delay treatment for those suffering from alcohol or opioid use disorder,” Urso said. “These delays open the door to relapse at critical times during a person’s treatment, putting patients at risk.”
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The legislation covers reviews that occur before the medication is delivered to the patient and that happen while the treatment is ongoing. For utilization reviews under Medicaid, the bill would require Medicaid managed care organizations to use the criteria selected by the R.I. Executive Office of Health and Human Services to determine medical necessity.
The legislation gained support from both R.I. Department of Corrections Director Wayne T. Salisbury Jr, who has since left that position, and Richard Leclerc, director of the R.I. Department of Behavioral Healthcare, Developmental Disabilities and Hospitals.
Leclerc said, “Given the ongoing impact of overdoses in Rhode Island, where hundreds still die each year despite declines, we must continue to identify and address unnecessary barriers that delay treatment and place more people at risk.”
The measure now moves to the R.I. House of Representatives, where Rep. John G. Edwards, D-Tiverton, has introduced similar legislation.
Christopher Allen is a PBN staff writer. You may contact him at Allen@PBN.com.
