What's happening
This bill requires insurance policies to cover opioid medications without prior authorization and at the same rate for all opioids.
Why it matters
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Require Opioid Coverage By Insurers
Plain English, a few words. Used as the page title.
Sponsors
2 Co-sponsors
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 Insurance for Opioids
In Assembly Committee · Insurance · Sponsor Linda Rosenthal
Full text
2 pagesUnderlined is new[Struck] is removedOfficial text on nysenate.gov ↗
STATE OF NEW YORK
4500
2019-2020 Regular Sessions
IN SENATE
March 13, 2019
Introduced by Sen. HARCKHAM -- 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 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 authorization from the insurance company prior to administration or
EXPLANATION--Matter in italics (underscored) is new; matter in brackets
[ ] is old law to be omitted.
LBD01843-01-9
S. 4500 2
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.
Sponsor's memo
Title of bill
An act to amend the insurance law, in relation to insurance coverage of opioid medications
Purpose
This bill requires that certain health insurance plans cover prescription opioid drugs for the entirety of a patient's treatment and does not restrict access to them by unreasonably raising cost or requir- ing prior authorization.
Summary of provisions
Section 1 amends subsection (i) of section 3216 of the insurance law.
Section 2 amends subsection (1) of section 3221 of the insurance law.
Section 3 amends section 4304 of the insurance law.
Section 4 sets forth the effective date.
Justification
The opioid crisis has reached every part of New York State, and recog- nizing the dangers associated with opioid painkillers, many ; individuals are choosing to seek pain medications with a lower risk of addiction or are avoiding opioid drugs altogether. However, many are finding it difficult to access these lower-risk alternatives due to restrictions by their insurance providers who are less willing to cover these higher priced drugs.
Many insurance companies restrict access to these medications by requir- ing prior authorization, charging higher co-payments, or simply refusing coverage altogether. All of these methods create a difficult and drawn out process for patients who are suffering from severe pain and can leave them with no option other than to accept the cheaper, more addic- tive opioid drugs.
With opioid deaths at an all-time high in our state and around the coun- try we should be working to ensure that patients have access to safest painkillers, ones with the lowest risk of addiction or dependency. This bill would ensure a patient's ability to obtain safer pain medications by requiring insurance companies to cover prescription opioid drugs, regardless of cost and without prior authorization, for the entirety of treatment.
Legislative history
2017-18: A.8710 - Referred to Insurance
Fiscal implications
Unknown.
Effective date
This bill shall take effect immediately.
Summaries, headlines and scores are AI-generated from the official bill text. How we score bills. Source: NYS Open Legislation.