Senate Bill S4532

                            
 
                     S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   4532
 
                        2021-2022 Regular Sessions
 
                             I N  S E N A T E
 
                             February 5, 2021
                                ___________
 
 Introduced  by  Sen.  BROUK  -- read twice and ordered printed, and when
   printed to be committed to the Committee on Health
 
 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 ASSEM-
 BLY, 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 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 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 PRESCRI-
 BERS 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.
              

                                                            LBD06823-01-1

 S. 4532                             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 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.
   § 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.