BOSTON — Access to the overdose-reversing drug naloxone can be had without a prescription in Massachusetts and a majority of states. A "standing order" allows nurses, drug counselors, family members or friends of people dealing with opioid addiction to carry and administer the life-saving medicine.
The expanded availability of naloxone, widely known by the brand name Narcan, has been credited with saving countless lives in recent years and blunting the deadly impact of a wave of addiction.
But lawmakers are now concerned that some who carry the drug, including physicians, may be rejected for disability, life or other long-term insurance policies.
A new proposal by Sen. Joan Lovely, D-Salem, would prohibit insurers from cancelling or rejecting applicants, or charging them higher premiums, "based solely on a prescription to carry or possess the drug naloxone." Companies that violate the rules could be fined by state regulators for "unfair or deceptive acts" under the proposal.
Lovely, the Senate's assistant majority leader, said she's been made aware of physicians who've lost coverage because they carry naloxone, and she's concerned about a chilling effect on good Samaritans "who are trying to do the right thing."
"This medicine saves lives, and if people are thinking they're going to lose their life or disability insurance simply by filling a prescription for it, that's a serious problem," she said.
Lovely said she wants to prevent insurers from lumping people who carry naloxone to save others in with those suffering from addiction, who carry it because they are at risk of dying from an overdose. The latter, more risky group is far less likely to qualify for life insurance or other coverage.
Lovely said she recently underwent training to administer naloxone after seeing a man overdose in a supermarket. She now carries a Narcan rescue kit.
"Thankfully I haven't had to use it," she said. "But you never know if you'll need it, and we need to make sure more people have access to this medicine."
State agency responds
The issue has caught the attention of the state Division of Insurance, which issued a bulletin in February warning insurers not to deny coverage to applicants solely because they have prescriptions for naloxone or other opioid antagonists. Doing so, the agency said, would "defeat the commonwealth's important public health efforts."
While insurance underwriters are permitted to review applicants' medical histories, including prescriptions, the state agency noted that naloxone, similar to some HIV drugs, "may be intended to prevent, not treat an existing illness or disease" and must be treated differently.
"Carriers need to be aware that Massachusetts law permits the purchase of naloxone rescue kits by friends and family of people who use opioids, and persons without substance use disorder may have prescriptions for or purchase naloxone in order to assist others," Gary Anderson, the state's insurance commissioner, wrote in the advisory.
Last year, the American Council of Life Insurers issued a statement in response to the concerns saying that insurers support the efforts of good Samaritans and policies to make naloxone more accessible. At the same time, the group defended the practice of reviewing prescriptions as part of applications for coverage.
"The clearer the picture life insurers have of applicants’ medical situations, the more accessible and affordable coverage is for all," the statement read. "Indeed, a life insurer would not be doing its job of assessing the risks it assumes on behalf of current and future policyholders if it did not notice and evaluate such a prescription."
Lovely said the current rules aren't enough to prevent insurers from denying coverage to people based on naloxone prescriptions. She wants the protections baked into state law.
Her proposal would require insurers to review information "to determine if an applicant has obtained such a prescription for a reason not relevant to the applicant’s health." Naloxone counteracts the effects of heroin, fentanyl and other opioids.
A state program created by lawmakers several years ago purchases the life-saving medicine in bulk and then sells it to local police and fire departments at a reduced cost. The state has also eased pharmacy regulations to give the public more access to the drug.
Opioid-related deaths in Massachusetts fell about 4% from 2016 to 2018, according to state health officials, who attribute the decline, in part, to public access to naloxone. Still, nearly 2,000 people died from opioid-related overdoses in the state last year, most of them involving fentanyl.
The U.S. Surgeon General's Office has cited studies showing that expanding naloxone access has contributed to declines in opioid-related deaths.
Earlier this year, Sen. Ed Markey wrote to the National Association of Insurance Commissioners and other groups demanding answers from the industry.
"We must be doing all we can to make access to naloxone easier, not harder, for all Americans," wrote Markey, a Malden Democrat. "Knowing that carrying naloxone could result in the denial of an insurance policy application would undoubtedly dissuade individuals from obtaining it to help save the life of a loved one or even a stranger."