Narcan saves lives. The evidence is clear in the dropping number of opioid fatalities in Massachusetts and across the country. While the overall epidemic shows little sign of abating, fewer people are dying because first responders, doctors, nurses and loved ones have ready access to overdose-reversing naloxone.
The medicine is so vital that the state, to its credit, has done all it can to get doses of the drug into as many hands as possible. A “standing order” prescription allows medical professionals, drug counselors, family members — anyone, really — to carry and administer the drug. It can be obtained at almost any pharmacy and communities across the region that have trained citizens in its use.
Rescuers shouldn’t be penalized for using it. But that became an increasing concern last winter, when the life insurance company Primera refused to write a life insurance policy for a Boston Medical Center nurse after learning she had a prescription for naloxone. That the nurse was an addiction treatment specialist at the largest safety-net hospital in New England — making Narcan as vital a professional tool as a scalpel or stethoscope — mattered not a whit. The fact that Narcan was on the nurse’s personal med list was enough for Primera to decide the policy was too risky to write.
The nurse tried getting coverage from another life insurance company, and was told she could buy a policy if she provided a letter from her doctor explaining why she needed Narcan. The primary care physician, however, didn’t write the prescription — the nurse picked it up herself under the state’s “standing order.” So no insurance from the second company either.
Earlier this year, the state Division of Insurance issued a bulletin that warned insurers not to deny coverage to applicants simply because they had prescriptions for opioid antagonists, saying that doing so would “defeat the commonwealth’s important public health efforts.”
The life insurance industry says it supports the efforts to make naloxone more widely available but has stopped short of committing to ensuring coverage won’t be unfairly denied, and said it will continue reviewing applicants’ prescriptions.
“The clearer the picture life insurers have of applicants’ medical situations, the more accessible and affordable coverage is for all,” the American Council of Life Insurers said in a statement last year. “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.”
Fair enough. But in the case of the Boston Medical Center nurse, not one but two insurance companies rejected her claim. They clearly noticed her prescription. But they didn’t evaluate it. And there’s no guarantee it won’t happen again to other applicants, which could have a chilling effect on efforts to make a lifesaving drug widely available.
“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,” state Sen. Joan Lovely told Statehouse reporter Christian Wade.
The Salem Democrat has filed legislation that would prohibit insurers from denying coverage simply because an applicant has a prescription to carry or possess naloxone. Specifically, the proposed law would require insurers review information “to determine if an applicant has obtained such a prescription for a reason not relevant to an applicant’s health.” Similar legislation is being considered in New York.
Lovely herself carries a Narcan rescue kit; she got trained in its use after seeing a man overdose in a supermarket.
“Thankfully, I haven’t had to use it,” she told Wade. “But you never know if you’ll need it, and we need to make sure more people have access to this medicine.”
We can start by making sure that people aren’t punished for carrying it.