What's happening
This bill requires health insurers in New York to cover FDA-approved opioid addiction treatment drugs without prior authorization or step therapy.
Why it matters
Removes administrative barriers to treatment. By prohibiting insurers from requiring prior authorization or step therapy for FDA-approved opioid addiction medications, this bill ensures that patients can access critical treatments without delays, which can be life-saving in acute situations.
Standardizes coverage across insurance plans. The bill applies to all major medical and prescription drug policies, meaning people insured under different types of plans will have consistent access to opioid addiction medications, reducing disparities in care.
Allows for cost-sharing, but with limits. While insurers can still require deductibles and co-insurance for these medications, the bill mandates that these out-of-pocket costs must be consistent with what is charged for other medical benefits, preventing excessive financial barriers.
Defines covered treatments clearly. By specifying that covered drugs must be FDA-approved for detoxification or maintenance of substance use disorder, the bill ensures that only scientifically validated medications are included, promoting evidence-based care.
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Insurers Must Cover Addiction Medication
Plain English, a few words. Used as the page title.
Sponsors
3 Co-sponsors
History
- Referred to insurance
- Print number 294a
- Amend 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.
Insurers Must Cover Addiction Meds
In Senate Committee · Insurance · Sponsor Pete Harckham
Full text
2 pagesUnderlined is new[Struck] is removedOfficial text on nysenate.gov ↗
STATE OF NEW YORK
294--A
2019-2020 Regular Sessions
IN ASSEMBLY (Prefiled)
January 9, 2019
Introduced by M. of A. L. ROSENTHAL, HUNTER, GALEF, D'URSO -- read once and referred 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 36 to read as follows:
(36)(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
EXPLANATION--Matter in italics (underscored) is new; matter in brackets
[ ] is old law to be omitted.
LBD01571-03-9
A. 294--A 2
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.
§ 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.
Summaries, headlines and scores are AI-generated from the official bill text. How we score bills. Source: NYS Open Legislation.