What's happening
This bill requires insurance plans to cover at least one abuse-deterrent opioid per ingredient and prevents prior authorization from mandating non-abuse-deterrent opioids first.
Why it matters
Reduces barriers for patients and prescribers seeking abuse-deterrent opioids. by preventing insurance plans from requiring people to try cheaper, more easily abused opioids before accessing safer, abuse-deterrent formulations—potentially decreasing risk of opioid misuse and diversion.
Ensures affordability for patients. by mandating that insurance cost-sharing (copays, coinsurance, deductibles) for abuse-deterrent opioids cannot be higher than for non-abuse-deterrent versions, making it less likely that patients will be financially disincentivized from choosing safer medication options.
Promotes broader access to improved opioid technology. by requiring insurance plans to cover at least one abuse-deterrent opioid per active ingredient, which could drive innovation, encourage pharmaceutical companies to develop more abuse-deterrent drugs, and help standardize safer prescribing practices across New York.
Restricts insurance companies from shifting costs or creating prescribing hurdles. the bill specifically bans insurers from increasing cost-sharing or adding other barriers for patients, prescribers, or pharmacies in order to comply with these new requirements, aiming to ensure that improved access is real and not offset by new restrictions.
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Who cares
Headline styles
Require Abuse-Deterrent Opioids
Plain English, a few words. Used as the page title.
Sponsors
Senator · Senate District 38
History
- Referred to insurance
- Delivered to assembly
- Passed senateVote 59–2
- Advanced to third reading
- 2nd report cal.
- 1st report cal.172
- Referred to health
- Returned to senate
- Died in assembly
- Referred to insurance
- Delivered to assembly
- Passed senateVote 62–0
Show 2 earlier actions
- Ordered to third reading cal.1329
- Referred to rules
Full text
2 pagesUnderlined is new[Struck] is removedOfficial text on nysenate.gov ↗
STATE OF NEW YORK
6397
2019-2020 Regular Sessions
IN SENATE
June 7, 2019
Introduced by Sen. CARLUCCI -- read twice and ordered printed, and when printed to be committed to the Committee on Rules
AN ACT to amend the public health law and 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. Section 273 of the public health law is amended by adding a new subdivision 11 to read as follows:
11. Any prior authorization requirements for opioid analgesic and any service denials made pursuant thereto shall not require use of opioid analgesic drug products without abuse-deterrent properties before authorizing the use of abuse-deterrent opioid analgesic drug products.
§ 2. 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 analgesics drug product per opioid analgesics 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.
EXPLANATION--Matter in italics (underscored) is new; matter in brackets
[ ] is old law to be omitted.
LBD13268-01-9
S. 6397 2
(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:
(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.
§ 3. 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 public health law and the insur- ance law, in relation to the use of abuse-deterrent 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 subdivision 11 to section 273 of the public health law to ensure patient access to abuse-deterrent opioid analgesic drugs by requiring that a minimum of one opioid abuse-deterrent opioid anal- gesic drug per opioid analgesic active ingredient is covered by insur- ance plans and to ensure that a patient is not required to take a non-a- buse deterrent opioid before an abuse-deterrent opioid version.
Section 2 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.
Section 3 is the effective date of the bill.
Justification
Abuse deterrent formulations (ADFs) represent a breakthrough technology that helps prevent the crushing, snorting, and injection of painkillers.
Currently, many prescription drug plans present access barriers for chronic pain patients to ADFs including cost-sharing tiers, fail-first requirements, and prior authorization requirements. Instead of receiving ADFs, often patients are limited to using traditional opioids that can be easily diverted, crushed, snorted, and injected.
The U.S. Food and Drug Administration (FDA)is encouraging the develop- ment of prescription opioids with abuse-deterrent formulations to help combat the opioid crisis. The agency recognizes that abuse-deterrent opioids are not abuse- or addiction-proof but are a step toward products that may help reduce abuse.
According to the FDA, "abuse-deterrent formulations target the known or expected routes of abuse, such as crushing in order to snort or dissolv- ing in order to inject, for the specific opioid drug substance. The science of abuse deterrence is relatively new, and both the formulation technologies and the analytical, clinical, and statistical methods for evaluating those technologies are rapidly evolving."
Prior legislative history
New Legislation.
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.