What's happening
This bill requires New York health insurers to cover FDA-approved opioid addiction medications without prior authorization or step therapy.
Why it matters
Eliminates common insurance barriers. (like prior authorization and step therapy) that often delay or prevent access to medications for opioid addiction, potentially allowing patients to begin treatment more quickly when they seek help.
Aligns insurance coverage with medical best practices. by mandating coverage of all FDA-approved medications for opioid use disorder, supporting broader use of effective, evidence-based treatments.
Could reduce overdose deaths and improve recovery outcomes. by making it easier for people with opioid addiction to access and stay on medication-assisted treatment, which is proven to lower relapse and mortality rates.
Ensures parity with other covered benefits. by allowing insurers to apply the same deductibles and co-insurance as for other medical or prescription benefits, potentially avoiding large cost shifts but still expanding access.
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Who cares
Headline styles
Cover Opioid Addiction Medication
Plain English, a few words. Used as the page title.
Sponsors
2 Co-sponsors
History
- Print number 7905a
- Amend (t) and recommit 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.
Cover Opioid Treatment Medications
Assembly Floor Calendar · Sponsor Linda Rosenthal
Full text
2 pagesUnderlined is new[Struck] is removedOfficial text on nysenate.gov ↗
STATE OF NEW YORK
7905--A
IN SENATE
March 8, 2018
Introduced by Sens. GRIFFO, GOLDEN, HAMILTON -- read twice and ordered printed, and when printed to be committed to the Committee on Insurance -- committee discharged, bill amended, ordered reprinted as amended and recommitted to said committee
AN ACT to amend the insurance law, in relation to requiring health insurers to provide coverage of opioid addiction prescription drugs prescribed for the treatment of substance abuse disorder
The People of the State of New York, represented in Senate and Assembly, do enact as follows:
Section 1. Subsection (i) of section 3216 of the insurance law is amended by adding a new paragraph 35 to read as follows:
(35)(A) Every policy that provides medical, major medical or similar comprehensive-type coverage, or coverage for prescription drugs must provide coverage, without prior authorization or step therapy, for an initial or renewal prescription for prescription drugs prescribed for the treatment of substance abuse disorder suffered by a covered person with an addiction to opioids.
(B) Coverage provided under this paragraph may be subject to annual deductibles and co-insurance as deemed appropriate by the superintendent and that are consistent with those imposed on other benefits within a given policy.
(C) For the purposes of this paragraph, "prescription drugs prescribed for the treatment of substance abuse disorder" shall mean medications and prescription drugs approved by the food and drug administration for the detoxification or maintenance treatment of substance use disorder.
§ 2. Subsection (l) of section 3221 of the insurance law is amended by adding a new paragraph 7-c to read as follows:
(7-c)(A) Every policy that provides medical, major medical or similar comprehensive-type coverage, or coverage for prescription drugs must provide coverage, without prior authorization or step therapy, for an initial or renewal prescription for prescription drugs prescribed for the treatment of substance abuse disorder suffered by a covered person with an addiction to opioids.
EXPLANATION--Matter in italics (underscored) is new; matter in brackets
[ ] is old law to be omitted.
LBD14969-04-8
S. 7905--A 2
(B) Coverage provided under this paragraph may be subject to annual deductibles and co-insurance as deemed appropriate by the superintendent and that are consistent with those imposed on other benefits within a given policy.
(C) For the purposes of this paragraph, "prescription drugs prescribed for the treatment of substance abuse disorder" shall mean medications and prescription drugs approved by the food and drug administration for the detoxification or maintenance treatment of substance use disorder.
§ 3. Section 4303 of the insurance law is amended by adding a new subsection (l-3) to read as follows:
(l-3) Every contract that provides medical, major medical or similar comprehensive-type coverage, or coverage for prescription drugs must provide coverage, without prior authorization or step therapy, for an initial or renewal prescription for prescription drugs prescribed for the treatment of substance abuse disorder suffered by a covered person with an addiction to opioids. Coverage provided under this subsection may be subject to annual deductibles and co-insurance as deemed appropriate by the superintendent and that are consistent with those imposed on other benefits within a given contract. For the purposes of this subsection, "prescription drugs prescribed for the treatment of substance abuse disorder" shall mean medications and prescription drugs approved by the food and drug administration for the detoxification or maintenance treatment of substance use disorder.
§ 4. This act shall take effect immediately.
Reflowed for reading: line numbers and page breaks removed. Cite the official text.
Sponsor's memo
Title of bill
An act to amend the insurance law, in relation to requiring health insurers to provide coverage of opioid addiction prescription drugs prescribed for the treatment of substance abuse disorder
Purpose
This bill ensures that patients suffering from drug and alcohol depend- ency receive appropriate care, by requiring that health insurers to provide overage, without prior authorization, for an initial or renewal prescription for drugs prescribed for the treatment of substance abuse disorder.
Summary of provisions
Section one amends subsection (i) of section 3216 of the insurance law to provide that every policy providing medical, major medical or similar comprehensive-type coverage, or coverage for prescription drugs must provide coverage, without prior authorization, for an initial or renewal prescription for prescription drugs prescribed for the treatment of substance use disorder.
Section two amends subsection (1) of section 3221 of the insurance law to provide that every policy providing medical, major medical or similar comprehensive-type coverage, or coverage for prescription drugs must provide coverage, without prior authorization, for an initial or renewal prescription for prescription drugs prescribed for the treatment of substance use disorder.
Section three adds a new subsection to section 4303 of the insurance Law to provide that every contract that provides medical, major medical or similar comprehensive-type coverage, or coverage for prescription drugs must provide coverage, without prior authorization, for an initial or renewal prescription for prescription drugs prescribed for the treatment of substance use disorder.
Section four sets forth the effective date.
Justification
Opioid use has grown by epidemic proportions in recent years. There is significant need for accessible treatment options for individuals seek- ing medical treatment for addiction. However, in some reported instances, insurance companies have denied or sought to deny continued coverage for buprenorphine and other medications prescribed to treat opiate addiction. Insurance companies should not deny coverage for treatment options for opioid addiction recovery as prescribed by a doctor treating a patient in recovery.
This legislation would ensure that patients suffering from drug and alcohol dependency receive appropriate care by prohibiting insurance companies from denying coverage of medication for treatment of substance use disorder for an initial or renewal prescription for prescription drugs prescribed for the treatment of substance use disorder.
Legislative history
New in Senate.
Fiscal implications
Undetermined.
Effective date
Immediate.
Summaries, headlines and scores are AI-generated from the official bill text. How we score bills. Source: NYS Open Legislation.