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    Document Summary
    - Report Published -

    House Document No. 5

    Document Title
    Abuse Deterrent Formulations for Opioid Medications (HJR 630, 2015)

    Health Insurance Reform Commission

    Enabling Authority
    HJR 630 (Regular Session, 2015)

    Executive Summary
    House Joint Resolution 630 was introduced in the 2015 Session of the General Assembly by Delegate Byron. The resolution, which passed both houses unanimously, directed the Health Insurance Reform Commission (HIRC) to study mandating health insurance coverage for abuse deterrent formulations (ADF) for opioid medications. ADF opioids are opioid drugs that are formulated in such a way that deters misuse and abuse, including making it difficult to snort or inject the drug for a more intense "high." In conducting its study, the HIRC was directed to examine the issues of access by citizens of the Commonwealth to effective pain management medications and the need to require the adoption of ADF technologies for pain medicines in order to assist in the Commonwealth's continuing efforts to eliminate substance and prescription drug abuse. The HIRC was required to complete meetings by November 30, 2015, and to submit an executive summary of its findings and recommendations by the first day of the 2016 Regular Session.

    The HIRC received testimony from interested persons at its July 15, 2015, meeting. At the December 1, 2015, meeting, staff summarized some of the testimony previously received, including the conclusion of the Bureau of Insurance (BOI) that because there is no specific requirement for coverage for this type of medication, imposing such a requirement could result in a cost to the Commonwealth. Members were also reminded of testimony by the Virginia Association of Health Plans that "next-generation" ADF opioids have not yet been approved by the FDA.

    According to the BOI, there is no specific requirement for this coverage for this type of medication, and imposing such a requirement could result in a cost to the Commonwealth. The Governor’s Task Force on prescription Drug and Heroin Abuse has not examined this issue.

    Delegate Byron noted that this is an issue of serious concern that needs continued monitoring. She noted her intent to introduce a resolution to continue the study pursuant to House Joint Resolution 630 for another year.

    The members of the HIRC unanimously recommended that the study be extended for a second year.

    The Health Insurance Reform Commission does not intend to submit a report of its findings and recommendations for publication as a House document.