Activists and lawmakers in New York are furious over a New Year’s Eve decision by New York Governor Andrew Cuomo to veto a bill intended to make it easier for low income residents on Medicaid to access medication-based treatment for opioid addiction—while signing a similar bill that does expand access to these medications for people on private insurance.
Both bills were designed to ban the use of something called prior authorization for people prescribed certain medication-assisted treatments (MAT) for opioid use disorder. Insurers claim that prior authorizations lower the risk of patients getting unneeded or overpriced name-brand medications instead of cheaper generics, but critics have long complained that the authorization process wastes precious time and resources and freezes out some people from getting care at all.
Some MAT drugs block the effects of opioids on the body, which can help people detox. Other drugs, such as buprenorphine and methadone, are opioids themselves, but they reduce the risk of overdose and other health problems by acting as replacements for more potent and dangerous drugs like heroin. While some people taking MAT may eventually wean themselves off opioid use completely, others may need lifelong treatment. But regardless of how long people stay on MAT, these drugs are well documented to improve the safety of people living with unhealthy opioid dependence.
As the death toll of the opioid crisis continues to grow, many patient advocates and doctors have pushed for policies and laws that would make it easier for people to access MAT. One popular demand has been to strike down the practice of prior authorization for these drugs, which requires doctors to first get approval from an insurer for their prescribed treatment before it will be covered.
Last summer, two separate bills outlawing prior authorization on MAT drugs for New York residents on Medicaid and private insurance plans garnered overwhelming, bipartisan support from state lawmakers. Activists criticized Cuomo for not immediately signing the bills into law, and now they’re protesting the veto of the bill aimed specifically at ending prior authorization for MAT drugs covered by Medicaid.
“After six months of pleading for a signature, Governor Cuomo callously vetoed the bill to expand lifesaving treatment to thousands of low-income New Yorkers grappling with substance use disorders,” Jasmine Budnella, drug policy coordinator for the New York chapter of the group Voices Of Community Activists & Leaders (VOCAL-NY), said in a statement posted on its Twitter account.
VOCAL-NY has not yet responded to a request for comment from Gizmodo.
When reached for comment, Governor Cuomo’s office directed Gizmodo to the memo outlining the decision to veto the bill. The office’s justifications for the veto stated in the memo are largely budgetary. For instance, the memo claims that passing the bill in its current form would have allowed one pharmaceutical company to overcharge Medicaid for its versions of MAT drugs, an excess cost to the state that they estimated to be $30 million.
The memo also argued that changing the policy for methadone would have endangered people’s lives. Currently in New York, prior authorization is waived for people taking methadone at a specialized clinic. But because methadone is sometimes “diverted” (meaning, it’s sold or given to other people besides the patient) and abused similarly to opioids taken recreationally, the memo argues, the risk of diversion for methadone prescribed outside of these clinics would have been too great.
“This bill is a giveaway to manufacturers, risks the important progress we have made to combat opioid use disorder and does not have any clinically beneficial impact for New Yorkers,” the memo stated.
Critics of the veto, however, have their own rebuttals. In the VOCAL-NY statement, Budella cites an analysis that estimated an annual cost savings of $51.9 million from the bill, largely by reducing inpatient hospitalizations and ER visits caused by opioid overdoses. The group also estimates the bill would save nearly 600 lives in the state annually.
And though methadone may carry a higher risk of overdose than buprenorphine (since it’s a full, not partial opioid), buprenorphine is often diverted more. Most cases of diversion for either drug also involve people taking them illegally to manage their withdrawal symptoms or dependence to other opioids like heroin, not to get high, according to the National Institute on Drug Abuse.
New York Assemblymember Linda B. Rosenthal (D/WF-Manhattan), who sponsored the Assembly version of the Medicaid bill, told Gizmodo in a statement via email that Cuomo’s signing of one bill but not the other is indefensible.
“The veto institutionalizes a two-tiered system of addiction treatment whereby the wealthy can more quickly access lifesaving drugs, while vulnerable New Yorkers must continue to jump through hoops, increasing the likelihood that they die while doing so,” she said.
Cuomo’s office has pledged that they would find a way to expand MAT access for people on Medicaid this year. In the memo, they outline a proposal to create a single list of preferred MAT drugs that would be available for all Medicaid patients, without allowing manufacturers to “name their price.”
But activists aren’t waiting to take action. This afternoon, they held a protest at Cuomo’s office in Manhattan.
“This is what #DeadlyAusterity looks like. We must #BanPA and ensure universal access to medication assisted treatment,” the poster circulating online for the protest read.
This article has been updated with comments from New York Assemblymember Linda B Rosenthal.