Buprenorphine is a drug used to treat substance abuse disorders. There are about five different medications containing buprenorphine that doctors can prescribe. They help people manage the symptoms of opioid withdrawal. 

If a patient can’t access buprenorphine, even for one day, he or she could begin going through withdrawal, which could then lead to purchasing drugs on the street, where much of what is sold is cut with illegal and deadly fentanyl.

In 2019, two bills addressing this issue were passed by the New York state Legislature and presented to Gov. Andrew Cuomo to sign. One ensured that an individual with private insurance would be able to obtain any medication containing buprenorphine that a doctor has prescribed without prior authorization. He signed it.

The second bill did the same thing, but for Medicaid patients rather than patients with private insurance. Cuomo vetoed it.

The issue is money. 

New York State Medicaid has a list of drugs used for medication-assisted treatment that it prefers prescribers use. If a drug is not “preferred," an individual will need prior authorization, also known as “prior auth," to obtain that medication. 

The primary reason some drugs are preferred is because pharmaceutical companies provide Medicaid with a discount on them. 

In 2020, the state said it would reopen the process to approve a new formulary for addiction medications. But some of the companies didn’t offer sufficient rebates. The upshot? Even with this compromise, there remain some buprenorphine medications that are preferred and some that are not. 

Fast forward to 2021. 

State Sen. Pete Harckham’s Medicaid Prior Authorization Bill (S649A/A2030) was again passed by the legislature. It’s now waiting for Gov. Kathy Hochul’s signature. 

Harckham, who chairs the Senate Committee on Alcoholism and Substance Abuse, summed up the current situation this way.

“If you’re privileged enough to have private insurance, you can have whatever medication you want without prior auth, but if you’re on Medicaid, you either take the medication that’s on the list, that may not be appropriate for you, or you have to go through a lengthy prior auth process,” Harckham explained.

Harckham told Capital Tonight he’s hoping the wrinkles that prevented the Cuomo administration from signing off on the bill in 2019 can be ironed out with the Hochul administration.

“It was a cost issue for them,” explained Harckham of the Cuomo administration. “They were saying this would cost anywhere between $18 and $20 million, and that was the former governor’s Medicaid cap." 

Countering that argument, Harckham said that his bill would save $50 million a year in Medicaid costs, from hospitalizations and emergency room visits.

“You’re saving lives and saving money, but you need to have an additional output of money at the front end to save money on the backend,” Harckham said.

There were 5,500 New Yorkers who died of drug overdoses in the last year.