Insurance companies argue that the legislation would contribute to higher health coverage costs
By: Steph Quinn
Missouri Independent
A Missouri House committee on Thursday approved legislation aimed at reducing barriers for patients to access nonopioid medications prescribed by health professionals, an effort by lawmakers to help prevent Missourians from developing opioid use disorders.
The legislation, sponsored by Republican state Reps. Melanie Stinnett of Springfield, Brian Seitz of Branson, Tara Peters of Rolla and Kent Haden of Mexico, would prohibit insurance companies from denying coverage of a prescribed nonopioid in favor of an opioid or requiring a higher co-pay for a nonopioid.
The House Health and Mental Health Committee gave it unanimous approval Thursday morning.
“The goal of the bill really is to make sure that a patient and a physician get to have a discussion about whatever their pain management plan should look like,” Stinnett told The Independent.
Representatives of insurance companies testified that the legislation would unfairly favor a nonopioid painkiller approved by the U.S. Food and Drug Administration last year and stymie efforts to curb costs.
But state lawmakers on the committee pushed back in a hearing last week, arguing that insurance companies’ savings don’t transfer to patients and pointing out that the bills don’t mandate medical providers to prescribe the new medication.
Hampton Williams, testifying on behalf of the Missouri Insurance Coalition, said the bills would amount to “creating a monopoly,” saying Journavx is the only nonopioid drug the FDA has approved to treat acute pain.
But Journavx is not the only nonopioid doctors can prescribe for acute pain, which the legislation defines as expected to last 30 days or fewer.
Democratic state Rep. Gregg Bush of Columbia, a registered nurse, listed Toradol, gabapentin and some over-the-counter medications as other options.
“If there’s a physician that believes that Tylenol is the treatment plan for their patient, they may prescribe Tylenol even though it’s available over the counter,” Bush said.
An amendment added Thursday expanded provisions of the legislation to cover chronic as well as acute pain.
The legislation would also prohibit insurance companies from requiring patients to try a cheaper or generic opioid before covering a nonopioid prescribed by their doctor.
Witnesses on behalf of insurance companies said stricter regulations contribute to the rising cost of coverage to Missourians, pointing to the legislation as an example.
Williams said the measures would force insurance carriers to cover more expensive brand-name drugs.
“We identified from the last hearing that there are generic, nonopioid alternatives available,” Williams said. “Those should be allowed to be presented to customers at a more affordable price, and there will be costs associated if you eliminate those cost sharing ideas.”
But the legislation only prohibits carriers from requiring patients to try an opioid when they have been prescribed a nonopioid.
Republican state Rep. Becky Laubinger of Park Hills said during the Jan. 22 hearing that with Missourians already investing in higher premiums every month, they should be able to access medications prescribed to them.
“There’s frustration when the doctor believes one treatment is best and the insurance company says, ‘No, it’s not. We’re going to try something else first,” Laubinger said. “Why does the insurance company get to speak in front of the doctor for treatment?”