What's happening
This bill requires insurance plans to cover at least one abuse-deterrent opioid per active ingredient, with no higher cost-sharing than non-abuse-deterrent opioids.
Why it matters
Aims to reduce opioid abuse and diversion. by making abuse-deterrent opioid medications more accessible and affordable, potentially decreasing the misuse of prescription opioids and their associated harms.
Prevents insurance plans from placing financial barriers. (such as higher copays or deductibles) on abuse-deterrent opioids compared to traditional opioids, removing a cost incentive for patients to choose potentially riskier drugs.
Prohibits insurers from using utilization management tactics. (like prior authorization or step therapy) to force patients to try non-abuse-deterrent opioids before accessing safer, abuse-deterrent options, supporting patient and prescriber choice.
Could influence prescribing practices. by encouraging physicians to consider abuse-deterrent formulations for pain management, potentially impacting opioid prescribing trends and promoting public health goals.
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Who cares
Insurance carriers and health plans
They would have to cover at least one abuse-deterrent opioid product per opioid analgesic active ingredient and could not require use of a non-abuse-deterrent opioid first.
Patients prescribed opioid analgesics
Cost-sharing for covered abuse-deterrent products would be capped at the lowest level for covered non-abuse-deterrent opioids in the corresponding brand-name or generic category.
Prescribers and pharmacists
Plans could not impose disincentives on prescribers or dispensers to comply with the coverage requirements.
Manufacturers of abuse-deterrent opioids
Products with FDA-approved abuse-deterrence labeling would qualify for the bill’s coverage and cost-sharing protections.
Headline styles
Protect Access to Safer Opioids
Plain English, a few words. Used as the page title.
Sponsors
1 Multi-sponsor
History
- Referred to insurance
- Referred to insurance
Companion bill
The same bill in the other chamber. A bill becomes law when one version passes both houses and the governor signs it, so either number can carry it.
Limit Opioid Substitutions
In Senate Committee · Insurance · Sponsor Andrew J. Lanza
Full text
2 pagesUnderlined is new[Struck] is removedOfficial text on nysenate.gov ↗
STATE OF NEW YORK
7999
2017-2018 Regular Sessions
IN ASSEMBLY
May 25, 2017
Introduced by M. of A. CUSICK, SIMANOWITZ, BRINDISI, PEOPLES-STOKES -- Multi-Sponsored by -- M. of A. LUPARDO -- read once and referred to the Committee on Insurance
AN ACT to amend the insurance law, in relation to the use of abuse-deterrent technology for opioids as a mechanism for reducing abuse and diversion of opioid drugs
The People of the State of New York, represented in Senate and Assembly, do enact as follows:
Section 1. The insurance law is amended by adding a new section 3216-a to read as follows:
§ 3216-a. Access to abuse-deterrent opioid medications. (a) An insurance carrier or health plan shall provide coverage on its formulary, drug list or other lists of similar construct for at least one abusedeterrent opioid analgesic drug product per opioid analgesic active ingredient.
(1) Cost-sharing for brand name abuse-deterrent opioid analgesic drug products covered pursuant to this section shall not exceed the lowest cost-sharing level applied to brand name non-abuse deterrent opioid drugs covered under the applicable health plan or policy.
(2) Cost-sharing for generic abuse-deterrent opioid analgesic drug products covered pursuant to this section shall not exceed the lowest cost-sharing level applied to generic non-abuse deterrent opioid drugs covered under the applicable health plan or policy.
(3) An increase in patient cost-sharing or disincentives for prescribers or dispensers shall not be allowed to achieve compliance with this section.
(b) Any prior-authorization requirements or other utilization review measures for opioid analgesics, and any service denials made pursuant thereto, shall not require use of opioid analgesic drug products without abuse-deterrent properties in order to access abuse-deterrent opioid analgesic drug products.
EXPLANATION--Matter in italics (underscored) is new; matter in brackets
[ ] is old law to be omitted.
LBD11878-01-7
A. 7999 2
(c) Definitions. As used in this section:
(1) "Opioid analgesic drug product" means a drug in the opioid analgesic drug class prescribed to treat moderate to severe pain or other conditions, whether in immediate release or extended long acting release form and whether or not combined with other drug substances to form a single drug product or other dosage form.
(2) "Abuse deterrent opioid analgesic drug product" means a brand or generic opioid analgesic drug product approved by the federal food and drug administration with abuse-deterrence labeling claims indicating its abuse-deterrent properties are expected to deter or reduce its abuse.
(3) "Cost-sharing" means any coverage limit, copayment, coinsurance, deductible or other out-of-pocket patient expense requirements.
§ 2. This act shall take effect on the one hundred twentieth day after it shall have become a law, and shall apply to all policies and contracts issued, renewed, modified, altered or amended on or after such date.
Reflowed for reading: line numbers and page breaks removed. Cite the official text.
Summaries, headlines and scores are AI-generated from the official bill text. How we score bills. Source: NYS Open Legislation.