What's happening
This bill requires insurance plans in New York to cover at least one abuse-deterrent opioid per active ingredient, with no higher patient costs than non-abuse-deterrent opioids.
Why it matters
Expands patient access to safer opioid medications. by ensuring that insurance plans must include at least one abuse-deterrent formulation for every opioid ingredient, potentially reducing the risk of misuse and addiction among those who require pain management.
Prevents insurers from discouraging use of abuse-deterrent opioids through higher costs. patients cannot be charged more for these formulations than for traditional opioids, which removes a financial barrier to accessing potentially safer medication options.
Blocks insurance practices that would steer patients toward riskier medications. ; the bill prohibits insurers from requiring patients to try non-abuse-deterrent opioids before accessing abuse-deterrent versions, supporting clinical decisions that prioritize patient safety.
Limits insurance company cost-shifting tactics. by barring increases in patient cost-sharing or imposing penalties on prescribers and pharmacists as a way to comply, ensuring the law’s intent isn’t undermined by indirect financial disincentives.
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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 active ingredient and could not require use of a non-abuse-deterrent opioid first.
Patients prescribed opioid pain medications
Cost-sharing for covered abuse-deterrent products would be capped at the lowest level for covered non-abuse-deterrent opioids, comparing brand-name drugs with brands and generics with generics.
Opioid prescribers and pharmacists
The bill would prohibit disincentives for prescribers or dispensers as a means of complying with its coverage requirements.
Manufacturers of abuse-deterrent opioid medications
Products with FDA-approved abuse-deterrence labeling would qualify for the bill’s coverage and cost-sharing protections.
Headline styles
Limit Opioid Substitution Options
Plain English, a few words. Used as the page title.
Sponsors
No co-sponsors yet.
History
- Referred to insurance
- Referred to insurance
Full text
2 pagesUnderlined is new[Struck] is removedOfficial text on nysenate.gov ↗
STATE OF NEW YORK
3272
2019-2020 Regular Sessions
IN SENATE
February 5, 2019
Introduced by Sen. LANZA -- read twice and ordered printed, and when printed to be committed 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.
(c) Definitions. As used in this section:
EXPLANATION--Matter in italics (underscored) is new; matter in brackets
[ ] is old law to be omitted.
LBD08211-01-9
S. 3272 2
(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.
Sponsor's memo
Title of bill
An act to amend the insurance law, in relation to the use of abuse-det- errent technology for opioids as a mechanism for reducing abuse and diversion of opioid drugs
Purpose or general idea of bill
To help prevent the abuse and diversion of opioid analgesic drugs by ensuring that abuse-deterrent drugs approved by the FDA are accessible to patients and that that insurance coverage does not disadvantage access for patients to drugs approved by the FDA as abuse-deterrent.
Summary of specific provisions
Section 1 adds a new section 3216-a to the insurance law to ensure patient access to abuse-deterrent opioid analgesic drugs by requiring that a minimum of one opioid abuse-deterrent opioid analgesic drug per opioid analgesic active ingredient is covered by insurance plans and to ensure that a patient is not required to take a non-abuse deterrent opioid before an abuse-deterrent opioid version.
Read the full memo (605 words)
Section 2 is the effective date of the bill.
Justification
While pain management is an important and integral part of the health care system, abuse and diversion of opioids has necessitated the imple- mentation of various anti-abuse policies. These policies need to be approached comprehensively by government, law enforcement, health care providers and manufacturers and an important component is to ensure that opioids incorporating abuse-deterrent technologies are dispensed whenev- er possible.
The U.S. Food and Drug Administration (FDA) has recognized that the development and implementation of abuse-deterrent technologies is an important "step towards the goal of creating safer opioid analgesics." In recently published FDA guidance on abuse-deterrent technologies for opioids, the FDA provided that they "consider the development of these products a high public health-priority."
To combat opioid misuse and abuse, the FDA is encouraging manufacturers to develop abuse-deterrent formulations that when taken as prescribed still provide appropriate pain relief, but are-formulated to make it more difficult to alter the drug product for purposes of misuse or abuse, such as making the product harder to crush or liquefy in order to snort or inject. The FDA has provided guidance as to the steps that a manufacturer can take to demonstrate that an opioid drug product is formulated with abuse-deterrent technologies and after rigorous testing has shown that the abuse-deterrent formulation is expected to deter or reduce abuse of the drug product. It is only after achieving successful results on these tests that the FDA will allow for a drug product's label to include claims based on demonstration of meaningful abuse-det- errent properties.
This proposal recognizes that to further the goal of encouraging the use of abuse-deterrent technologies as part of a broader plan to reduce opioid addiction and abuse, it is imperative that insurance coverage is applied equitably and does not provide a disincentive to the use of abuse-deterrent opioids.
This will help advance safe patient care by ensuring that abuse-deter- rent versions of available opioid analgesic drug products are covered, including those containing nonopioid drug substances to form a single drug product.
While New York State has been at the forefront of fighting prescription drug abuse, it is critical that the State continue to strengthen its laws and protect against abuse while enhancing the integrity of its health care system. Enacting this proposal will be consistent with these goals and with the priorities set out by the FDA.
Prior legislative history
2018: S.7009 - Referred to Insurance / A.7999 - Referred to Insurance 2017: A.7999 - Referred to Insurance
Fiscal implications
None.
Effective date
This act shall take effect on the 120th day, and shall apply to all policies and contracts issued, renewed, modified, altered or amended on or after such date.
Summaries, headlines and scores are AI-generated from the official bill text. How we score bills. Source: NYS Open Legislation.