S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   7009
 
                             I N  S E N A T E
 
                                (PREFILED)
 
                              January 3, 2018
                                ___________
 
 Introduced  by  Sen.  LANZA  -- 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 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.
   (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
 
              
             
                          
                  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
                                                            LBD11878-01-7
 S. 7009                             2
 
 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.