1. Ganapa, Somnath V. BS
  2. Cheng, Glen MD, JD
  3. Halperin, William MD, DrPH, MPH

Article Content

Mandated Health Benefits Commissions (MHBCs) can play an important role in combating the ongoing opioid crisis. MHBCs recommend to state legislatures whether a health benefit (eg, a prescription drug or treatment) should be made mandatory for private insurance plans offered in their states. A guiding concept is that the greater the number of mandated health benefits, the more expensive the premiums of health insurance plans, possibly leading to lower insurance participation and insurance coverage. State legislatures have created MHBCs to obtain judicious guidance on mandating benefits. The guidance is based on a careful analysis of the health benefit's social benefits, medical effectiveness and safety, and financial costs. The composition of each MHBC varies by state, but MHBCs generally consist of state-appointed health care professionals, hospital administrators, insurance and labor representatives, and other professionals, bringing together the expertise needed to determine whether a health benefit should be mandated by the state legislature.


One example of the role of MHBCs was their evaluation of the utility of abuse-deterrent opioids in the wake of the opioid crisis. In 2017 alone, there were 47 600 opioid overdose deaths in the United States.1 In recent years, pharmaceutical companies have advocated for the use of "abuse-deterrent formulation" (ADF) opioids to prevent certain forms of opioid-related abuse. ADF opioids possess chemical and/or physical properties that make them more difficult to abuse by chewing, snorting, and intravenous injection. In 2017, the NJ legislature considered Senate Bill 1313 (NJ S1313), a bill that would mandate insurance coverage of ADF opioids.2


The NJ MHBC found the empirical evidence for the benefits of ADF opioids inconclusive for several reasons with which we agree. First, while the casing of ADF opioids makes them resistant to some forms of abuse, they can still be swallowed in large quantities to cause addiction.2 Second, many physicians mistakenly believe that ADF opioids cannot be abused or cannot cause addiction and are less cautious about prescribing the opioids.2 While only a fraction of patients taking opioids will develop addictions, the increased rate of prescriptions could increase the number of people addicted to opioids. Third, because it is more difficult for patients to abuse their prescription ADF opioids, they may turn to illicit, cheaper opioids such as street fentanyl and heroin, leading to increased opioid-related drug deaths. For these and other reasons, and in light of the estimated $111 million cost to New Jersey in the first year alone of making abuse-deterrent opioids a mandatory health benefit,2 the NJ MHBC stated that "abuse-deterrent opioids are not the panacea for opioid addiction that their title might suggest."2


Drawing from the expertise of its members, MHBCs can provide evidence-based recommendations regarding whether a proposed health benefit should be mandated by the state legislature. In the case of ADF opioids, the NJ MHBC decided that the empirical evidence for ADFs was inconclusive and that making ADF opioids a mandatory health benefit could exacerbate the opioid crisis.2 Instead, the NJ MHBC urged a multifaceted approach, including making nonopioid treatments a first-line pain relief measure, increasing opioid education for prescribers, and expanding prescription monitoring programs.2


MHBCs have a useful role in gathering and weighing the known and uncertain costs and benefits of new mandates proposed by state legislatures. We suggest that MHBCs share their analyses on open public forums to foster discussion of proposed mandated benefits so that MHBCs of every state may make the most informed decisions regarding proposed mandated health benefits.




1. Hedegaard H, Minino AM, Warner M. Drug Overdose Deaths in the United States, 1999-2017. Atlanta, GA: National Center for Health Statistics, Centers for Disease Control and Prevention. Published November 29, 2018. Accessed January 31, 2019. [Context Link]


2. The Mandated Health Benefits Advisory Commission, New Jersey Department of Banking and Insurance. A study of New Jersey Sen-ate Bill 1313. Accessed December 11, 2018. [Context Link]