Timothy O'Shea, MS, PharmD
Timothy O'Shea, MS, PharmD, is a Clinical Pharmacist working at a regional health insurance plan on the east coast. Additionally he works per diem at a nationwide retail pharmacy chain. He graduated from MCPHS University - Boston in 2015 and subsequently completed a PGY-1 Managed Care Pharmacy Residency. He completed his M.S. in Health Services Administration, with a focus on Health Economics and Outcomes, in 2018. His professional interests include pharmacy legislation and managed care pharmacy. He can be followed on Twitter at @toshea125.
The new legislation limits initial opioid prescriptions to a 5-day supply, making New Jersey’s limit 1 of the strictest in the country.2 Nine other states, including New York and Massachusetts, currently have legislation that limits opioid prescription to 7 days or less.
The law also mandates state-regulated health insurers cover the first 4 weeks of inpatient or outpatient substance abuse treatment without the need for authorization. Insurers must provide additional coverage for up to 6 months of treatment, including medication-assisted treatments, if deemed medically necessary. This means that prior authorizations on buprenorphine and naltrexone products for opioid dependence must be removed. According to Christie, the insurance mandate will prevent people from being denied drug treatment during a "preevaluation that can take weeks to complete."
The prescription drug limit would not apply to patients with cancer and for end-of-life hospice care. To address concerns about patients with pain that exceeds 5 days, the law allows physicians to easily add another 5 days to the original opioid prescription if the patient's pain has not subsided. Just an important, the law mandates physicians create a pain-management treatment plan for patients that require chronic opioid use. It also requires physicians to obtain a written record that the risks of taking opioids has been discussed with the patient.
More than 30,000 Americans died in 2015 from overdoses of prescription opioids and heroin, an epidemic widely considered by many to be the product of overprescribing of pain medicines. Data from the CDC show that the rate of heroin and fentanyl deaths in New Jersey have started to far outpace the national average. In 2015, nearly 1600 people drug of drug overdose representing a 22% increase from the previous year.
"We are here today to save lives," Christie said after signing the bill. The governor explained that "New Jersey now leads the way first and foremost in recognizing this is a disease."
The Medical Society of New Jersey has previously opposed opioid prescription limits calling them “intrusions into the practice of medicine” that are “cruel” by not taking into account individual patient circumstances.3 Additionally, some members of the Assembly Financial Institutions and Insurance Committee have expressed concern over the lack of information provided on what the mandate would cost insurance policy holders through increased premium.
The new law is set to take effect 90 days from the date it was signed into law. Like in other states, retail pharmacists will be responsible for adhering to the new prescribing limit when dispensing first-fill opioids; however, the exact role of New Jersey pharmacists in verifying whether an opioid fill is initial remains unclear. For example, after the opioid limit went into effect in New York, the board of pharmacy released guidance that pharmacists in the state are not required to verify with the prescriber whether an opioid prescription written for greater than a 7-day supply is in accordance with statutory requirements. They acknowledged a pharmacist may not know whether a 30-day supply is for initial treatment or not and deferred to the pharmacist’s discretion on the matter.
- Frostenson S. New Jersey just passed one of the most aggressive laws to combat the opioid epidemic. Vox. Feb 15 2017. Available at: www.vox.com/policy-and-politics/2017/2/15/14506434/republicans-democrats-opioid-abuse-bipartisan
- Gregory J. New Jersey law limits initial opioid prescriptions to five days. HealthExec. Feb 16 2017. Available at: healthexec.com/topics/care-delivery/nj-law-limits-initial-opioid-prescriptions-five-days
- Livio S. Christie plan to limit painkillers 'cruel,' N.J. doctors say. NJ.com. Jan 11 2017. Available at: www.nj.com/politics/index.ssf/2017/01/nj_doctor_group_opposes_christie_plan_to_limit_pai.html