What's happening
This bill requires insurance policies in New York to cover all prescribed opioid medications without prior authorization or rate differences.
Why it matters
Guarantees uninterrupted access. By prohibiting prior authorization for opioid prescriptions, the bill ensures patients receive timely pain management without delays that could worsen their condition or disrupt ongoing treatments.
Prevents cost discrimination. Requiring insurers to cover all opioid medications at the same rate eliminates potential financial barriers for patients whose doctors prescribe specific opioids, supporting individualized care over cost-driven decisions.
Standardizes coverage across plans. The bill applies to all types of medical and prescription drug insurance policies in New York, closing loopholes and ensuring consistent coverage regardless of the insurer or plan type.
Balances access with cost controls. While mandating coverage, the bill still allows insurers to apply annual deductibles and co-insurance (as regulated by the superintendent), maintaining some cost-sharing and oversight to prevent misuse or excessive spending.
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Who cares
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Require Insurance for Opioids
Plain English, a few words. Used as the page title.
Sponsors
No co-sponsors yet.
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.
Require Opioid Coverage By Insurers
In Senate Committee · Insurance · Sponsor Pete Harckham
Full text
2 pagesUnderlined is new[Struck] is removedOfficial text on nysenate.gov ↗
STATE OF NEW YORK
102
2019-2020 Regular Sessions
IN ASSEMBLY (Prefiled)
January 9, 2019
Introduced by M. of A. L. ROSENTHAL -- read once and referred to the Committee on Insurance
AN ACT to amend the insurance law, in relation to insurance coverage of opioid medications
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 of opioid medications and prescription drugs. Such coverage shall continue to be provided during the entire period of time the medications and drugs are prescribed or administered by an authorized prescriber or administrator. Such coverage shall not require prior authorization from the insurance company prior to administration or prescription of such medications and prescription drugs. Such coverage shall be at the same rate regardless of the opioid medications being administered or prescribed. An insurance company shall not charge a different rate for any medication in the opioid class.
(B) Coverage provided under this paragraph may be subject to annual deductibles and co-insurance as deemed appropriate by the superintendent.
§ 2. Subsection (l) of section 3221 of the insurance law is amended by adding a new paragraph 21 to read as follows:
(21) (A) Every policy that provides medical, major medical or similar comprehensive-type coverage, or coverage for prescription drugs must provide coverage of opioid medications and prescription drugs. Such coverage shall continue to be provided during the entire period of time the medications and drugs are prescribed or administered by an authorized prescriber or administrator. Such coverage shall not require prior
EXPLANATION--Matter in italics (underscored) is new; matter in brackets
[ ] is old law to be omitted.
LBD01843-01-9
A. 102 2
authorization from the insurance company prior to administration or prescription of such medications and prescription drugs. Such coverage shall be at the same rate regardless of the opioid medications being administered or prescribed. An insurance company shall not charge a different rate for any medication in the opioid class.
(B) Coverage provided under this paragraph may be subject to annual deductibles and co-insurance as deemed appropriate by the superintendent.
§ 3. Section 4303 of the insurance law is amended by adding a new subsection (l-3) to read as follows:
(l-3) (1) Every policy that provides medical, major medical or similar comprehensive-type coverage, or coverage for prescription drugs must provide coverage of opioid medications and prescription drugs. Such coverage shall continue to be provided during the entire period of time the medications and drugs are prescribed or administered by an authorized prescriber or administrator. Such coverage shall not require prior authorization from the insurance company prior to administration or prescription of such medications and prescription drugs. Such coverage shall be at the same rate regardless of the opioid medications being administered or prescribed. An insurance company shall not charge a different rate for any medication in the opioid class.
(2) Coverage provided under this paragraph may be subject to annual deductibles and co-insurance as deemed appropriate by the superintendent.
§ 4. This act shall take effect immediately.
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.