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.