What's happening
This bill prohibits insurance policies from requiring prior authorization for certain medications used to treat substance use disorders.
Why it matters
Reduces Delays in Accessing Addiction Treatment. By eliminating prior authorization for commonly used medications (buprenorphine, methadone, long-acting injectable naltrexone), the bill addresses a key barrier that often delays or prevents people from starting or continuing effective treatment for substance use disorders.
Targets High-Impact Medications. The medications specified are considered gold-standard, evidence-based treatments for opioid and other substance use disorders. Making them more readily accessible could lead to better recovery outcomes and potentially lower overdose rates.
Insurance Cost-Sharing Still Applies. While prior authorization is removed, insurers can still impose standard copayments, coinsurance, and deductibles. This means financial barriers may remain for some patients, but bureaucratic delays are lessened.
Standardizes Coverage Across Insurers. By amending multiple sections of insurance law, the bill ensures that various types of insurance policies (including large group and comprehensive plans) are all subject to the same requirements, reducing confusion and ensuring more consistent access for New Yorkers.
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Who cares
Headline styles
End Prior Authorization For Addiction Meds
Plain English, a few words. Used as the page title.
Sponsors
4 Co-sponsors
History
- Substituted by A2904
- Ordered to third reading cal.1142
- Committee discharged and committed to rules
- 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.
End Prior Authorization for Addiction Meds
Signed by Governor · Sponsor Dan Quart
Full text
2 pagesUnderlined is new[Struck] is removedOfficial text on nysenate.gov ↗
STATE OF NEW YORK
4808
2019-2020 Regular Sessions
IN SENATE
March 26, 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 prohibiting certain insurance policies from requiring prior authorization for certain medications used in the treatment of substance use disorders; and to repeal certain provisions of such law relating thereto
The People of the State of New York, represented in Senate and Assembly, do enact as follows:
Section 1. Paragraph 31-a of subsection (i) of section 3216 of the insurance law is REPEALED and a new paragraph 31-a is added to read as follows:
(31-a) (A) No policy that provides medical, major medical or similar comprehensive-type coverage and provides coverage for prescription drugs for medication for the treatment of a substance use disorder shall require prior authorization for an initial or renewal prescription for all buprenorphine products, methadone or long acting injectable naltrexone for detoxification or maintenance treatment of a substance use disorder except where otherwise prohibited by law.
(B) Coverage provided under this paragraph may be subject to copayments, coinsurance, and annual deductibles that are consistent with those imposed on other benefits within the policy.
§ 2. Paragraphs 7-a and 7-b of subsection (l) of section 3221 of the insurance law are REPEALED and a new paragraph 7-a is added to read as follows:
(7-a) (A) Every policy that provides medical, major medical or similar comprehensive-type large group coverage shall provide immediate coverage for all buprenorphine products, methadone or long acting injectable naltrexone without prior authorization for the detoxification or maintenance treatment of a substance use disorder.
EXPLANATION--Matter in italics (underscored) is new; matter in brackets
[ ] is old law to be omitted.
LBD01428-01-9
S. 4808 2
(B) Coverage provided under this paragraph may be subject to copayments, coinsurance, and annual deductibles that are consistent with those imposed on other benefits within the policy.
§ 3. Subsections (l-1) and (l-2) of section 4303 of the insurance law are REPEALED and a new subsection (l-1) is added to read as follows:
(l-1) (A) Every contract that provides medical, major medical, or similar comprehensive-type large group coverage shall provide immediate coverage for all buprenorphine products, methadone or long acting injectable naltrexone without prior authorization for the detoxification or maintenance treatment of a substance use disorder.
(B) Coverage provided under this paragraph may be subject to copayments, coinsurance, and annual deductibles that are consistent with those imposed on other benefits within the policy.
§ 4. This act shall take effect on the sixtieth day after it shall have become a law.
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 prohibiting certain insurance policies from requiring prior authori- zation for certain medications used in the treatment of substance use disorders; and to repeal certain provisions of such law relating thereto
Purpose
To ensure uniformity across all health insurance plan policies regarding reasonable patient access to medication assisted treatment for substance abuse disorders
Summary of provisions
Section 1 repeals subdivision 31-a of section 3216 of the insurance law and replaces it with a new subdivision to require health insurers to provide patient access, without prior authorization requirements, for initial and renewal prescriptions for buprenorphine and long-acting injectable naltrexone for the treatment of substance abuse disorders.
Section 2 repeals paragraphs 7-a and 7-b of subsection (1) of section 3221 of the insurance law and adds a new paragraph 7-a to require health insurers to provide patient access, without prior authorization require- ments, for initial and renewal prescriptions for buprenorphine and long- acting injectable naltrexone for the treatment of substance abuse disor- ders.
Section 3 repeals subsections (1-1) and (1-2) of section 4303 of the insurance law and adds a new subsection (1-1) to require health insurers to provide patient access, without prior authorization requirements, for initial and renewal prescriptions for buprenorphine and long-acting injectable naltrexone for the treatment of substance abuse disorders.
Section 4 provides that this act will take effect on the 60th day after enactment.
Justification
New York is experiencing an unprecedented heroin and opioid epidemic that is ravaging communities across the state. According to the New York State Comptroller's Office, New York has experienced an increase in death rates due to opioid and heroin addiction that outpaces almost any other state where data is available.
This bill builds upon measures enacted in 2016 to improve access to health insurance coverage for substance abuse treatment, including medi- cation assisted treatment. In 2016, prior authorization requirements were removed for buprenorphine and long-acting injectable naltrexone in the the Medicaid program. The purpose of this bill is to establish pari- ty fof all consumers by ensuring that addicted persons with commercial insurance coverage can access medication assisted treatment as prescribed by their health care providers without unnecessary barriers.
Legislative history
2017-2018: A7979 passed Assembly
Fiscal implications
None to the State.
Effective date
Sixty days after enactment.
Summaries, headlines and scores are AI-generated from the official bill text. How we score bills. Source: NYS Open Legislation.