Assembly Bill A7999

                            
 
                     S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   7999
 
                        2017-2018 Regular Sessions
 
                           I N  A S S E M B L Y
 
                               May 25, 2017
                                ___________
 
 Introduced  by  M. of A. CUSICK, SIMANOWITZ, BRINDISI, PEOPLES-STOKES --
   Multi-Sponsored by -- M. of A. LUPARDO -- read once  and  referred  to
   the Committee on Insurance
 
 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

   THE  PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
 BLY, 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 INSUR-
 ANCE CARRIER OR HEALTH PLAN SHALL PROVIDE  COVERAGE  ON  ITS  FORMULARY,
 DRUG  LIST  OR  OTHER LISTS OF SIMILAR CONSTRUCT FOR AT LEAST ONE ABUSE-
 DETERRENT 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 PRESCRI-
 BERS 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.
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
              

                                                            LBD11878-01-7

 A. 7999                             2
 
   (C) DEFINITIONS. AS USED IN THIS SECTION:
   (1)  "OPIOID  ANALGESIC DRUG PRODUCT" MEANS A DRUG IN THE OPIOID ANAL-
 GESIC 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.