- Obtaining settlements with major domestic and global health insurers including Cigna, Anthem, and Empire BlueCross BlueShield (BCBS), which insure over 4 million New Yorkers, to remove barriers to life-saving treatment for opioid use disorder. The agreements put an end to the insurers’ policy of requiring prior authorization for medication-assisted treatment (“MAT”), which can lead to significant delays for patients seeking relief from addiction.
- Launching a multistate investigation – as part of a bipartisan coalition of 41 attorneys general - into whether opioid manufacturers and distributors engaged in any unlawful practices in the marketing and distribution of prescription opioids.
- Creating the Internet System for Tracking Over-Prescribing Act (“I-STOP"), a series of enhancements to New York’s prescription drug monitoring program that provide doctors with patient’s up-to-date controlled substance prescription history and established a safe disposal program providing a place for New Yorkers to get rid of expired and unneeded drugs—thus reducing the likelihood of stolen and forged prescriptions being used to obtain controlled substances from pharmacies. I-STOP reduced “doctor shopping,” a practice in which an individual attempts to obtain the same or similar prescriptions from multiple physicians, by 90% since 2014.
- Launching the Community Overdose Prevention (“COP”) program, a life-saving initiative that enabled state and local law-enforcement officers in the state of New York to carry naloxone, the extremely effective heroin antidote that can immediately reverse the effects of an opioid overdose. Since the program’s implementation in April 2014, more than 100 overdoses were reversed using kits provided by the COP program, which distributed over 27,000 kits across the state.
- Obtaining an agreement with Amphastar Pharmaceuticals, Inc. to cut and cap the price of naloxone for all agencies in New York State, reducing the price of naloxone by nearly 20 percent.
- Enforcing Mental Health Parity Laws to reach agreements with health insurance companies, requiring them to implement sweeping reforms in their administration of behavioral health benefits, in particular relating to medical management practices, coverage of residential treatment for substance abuse, and co-pays for outpatient treatment, and to submit regular compliance reports. The agreements ultimately provided over $2 million in restitution for members whose claims for were improperly denied.
- Successfully prosecuting more than ten licensed prescribers including operators of “pill mills” and other unlawful practices for crimes related to improper opioid prescriptions.
- Cracking down on drug trafficking networks that traffic opioids into communities around the state. The Attorney General’s Organized Crime Task Force (OCTF) has now taken down 25 large drug trafficking gangs, made more than 580 felony narcotics arrests, and seized more than $1.5 million and more than 2,000 pounds of illegal drugs since 2011. In the past several months alone, Attorney General Schneiderman’s SURGE (Suburban and Upstate Response to the Growing Epidemic) Initiative has resulted in 260 alleged traffickers and dealers taken off the streets.
- Urging health insurance companies to review their coverage and payment policies that contribute to the opioid epidemic, as well as sending letters to the country’s three largest pharmacy benefit managers requesting documents, data, and other information regarding how they are addressing the opioid crisis.
This case was investigated by MFCU Principal Auditor Investigator Sarah Finning, Auditor Investigator Alyssa Filkins, and Investigator Joseph Farrell, with assistance from Regional Chief Auditor Charles Norfleet and Supervising Investigator Dianne Hart.