New legislation has been enacted by New York State to help combat the current heroin and prescription opioid abuse crisis. The NYS Public Health and Insurance Laws have been amended to include provisions that limit access to opioids and remove barriers when it comes to treatment for a substance abuse disorder.
As a result of this new legislation, effective July 22, 2016, health care providers are now restricted to prescribing no more than a 7-day supply of opioids for patients who are being treated for acute pain for the first time. Individuals who are prescribed opioids to treat pain associated with a chronic condition will be exempt from this new supply limit.
Independent Health will charge a prorated copayment for a 7-day supply of opioids for fully-insured members who are being treated for acute pain for the first time. For example, here’s how a $30 copay will be prorated:
- A member will be charged a $7 copay for the initial 7-day prescription of opioids.
- If the member needs to continue the medication for the remainder of the month, he or she will be charged a $23 copay for the second prescription (additional 23-day supply).
Since this provision does not pertain to self-funded insurance plans, self-funded plan participants will be charged a full copay for the initial 7-day prescription of opioids and a full copay for the second prescription if they need to continue taking the medication (up to a 23-day supply). However, self-funded groups do have the option to change their plan design so that their plan participants are also charged a prorated copay for a 7-day supply of opioids.
For more information about the new legislation, visit