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 insurance barriers to treatment. By eliminating requirements for prior authorization and step therapy, the bill ensures that people seeking opioid addiction treatment can access FDA-approved medications more quickly, which can be critical in preventing overdose and supporting recovery.
Applies broadly to insurance plans. The mandate covers a wide range of health insurance policies in New York, including both medical and prescription drug coverage, increasing the likelihood that more individuals with opioid use disorder will have access to these life-saving treatments.
Allows for typical cost-sharing. While insurers must cover these medications, they can still require patients to pay deductibles and co-insurance, as long as those costs are consistent with other covered benefits, meaning out-of-pocket costs could still be a factor for some patients.
Defines covered medications clearly. The bill specifically ties coverage to drugs approved by the FDA for detoxification or maintenance treatment of substance use disorder, providing clarity about which treatments must be included and aligning coverage with current medical standards.
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Who cares
Headline styles
Insurers Must Cover Addiction Meds
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.
Insurers Must Cover Addiction Medication
In Assembly Committee · Insurance · Sponsor Linda Rosenthal
Full text
2 pagesUnderlined is new[Struck] is removedOfficial text on nysenate.gov ↗
STATE OF NEW YORK
5535
2019-2020 Regular Sessions
IN SENATE
May 6, 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 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 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.
EXPLANATION--Matter in italics (underscored) is new; matter in brackets
[ ] is old law to be omitted.
LBD01571-02-9
S. 5535 2
(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.
Sponsor's memo
Title of bill
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
Purpose
This bill ensures that patients suffering from drug and alcohol depend- ency receive appropriate care, by requiring that health insurers provide coverage of opioid addiction medications during the entire period such medications are proscribed.
Summary of provisions
Section one amends subsection (i) of section 3216 of the insurance law.
Section two amends subsection (1) of section 3221 of the insurance law.
Section three adds a new subsection to section 4303 of the insurance law.
Section four sets forth the effective date.
Justification
Opioid use has grown by epidemic proportions in recent years. There is significant need for accessible treatment options for individuals seek- ing medical treatment for addiction. However, in some reported instances, insurance companies have denied or sought to deny continued coverage for buprenorphine and other medications prescribed to treat opiate addiction. Insurance companies should not deny treatment options for opioid addiction recovery as prescribed by a doctor treating a patient in recovery, nor should insurance companies dictate to any doctor or patient a specified amount of time that a patient can or should remain on such medication.
This legislation would ensure that patients suffering from drug and alcohol dependency receive appropriate care by prohibiting insurance companies from denying coverage of medication for treatment for opioid addiction during the entire period of time the medications and drugs are prescribed for such treatment by and authorized prescriber.
Legislative history
2017-18: A.4899-C - Ordered to Third Reading Calendar; S.7905-A - Referred to Insurance 2015-16: A.10237 - Referred to Insurance
Fiscal implications
Undetermined
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.