S T A T E O F N E W Y O R K
________________________________________________________________________
294--A
2019-2020 Regular Sessions
I N A S S E M B L Y
(PREFILED)
January 9, 2019
___________
Introduced by M. of A. L. ROSENTHAL, HUNTER, GALEF, D'URSO -- read once
and referred to the Committee on Insurance -- committee discharged,
bill amended, ordered reprinted as amended and recommitted to said
committee
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 ASSEM-
BLY, 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
EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
[ ] is old law to be omitted.
LBD01571-03-9
A. 294--A 2
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.
§ 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 APPRO-
PRIATE 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.