STATE OF NEW YORK
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4754
2023-2024 Regular Sessions
IN SENATE
February 14, 2023
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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:
1 Section 1. The insurance law is amended by adding a new section 3216-a
2 to read as follows:
3 § 3216-a. Access to abuse-deterrent opioid medications. (a) An insur-
4 ance carrier or health plan shall provide coverage on its formulary,
5 drug list or other lists of similar construct for at least one abuse-
6 deterrent opioid analgesic drug product per opioid analgesic active
7 ingredient.
8 (1) Cost-sharing for brand name abuse-deterrent opioid analgesic drug
9 products covered pursuant to this section shall not exceed the lowest
10 cost-sharing level applied to brand name non-abuse deterrent opioid
11 drugs covered under the applicable health plan or policy.
12 (2) Cost-sharing for generic abuse-deterrent opioid analgesic drug
13 products covered pursuant to this section shall not exceed the lowest
14 cost-sharing level applied to generic non-abuse deterrent opioid drugs
15 covered under the applicable health plan or policy.
16 (3) An increase in patient cost-sharing or disincentives for prescri-
17 bers or dispensers shall not be allowed to achieve compliance with this
18 section.
19 (b) Any prior-authorization requirements or other utilization review
20 measures for opioid analgesics, and any service denials made pursuant
21 thereto, shall not require use of opioid analgesic drug products without
22 abuse-deterrent properties in order to access abuse-deterrent opioid
23 analgesic drug products.
24 (c) Definitions. As used in this section:
EXPLANATION--Matter in italics (underscored) is new; matter in brackets
[] is old law to be omitted.
LBD08756-01-3
S. 4754 2
1 (1) "Opioid analgesic drug product" means a drug in the opioid anal-
2 gesic drug class prescribed to treat moderate to severe pain or other
3 conditions, whether in immediate release or extended long acting release
4 form and whether or not combined with other drug substances to form a
5 single drug product or other dosage form.
6 (2) "Abuse deterrent opioid analgesic drug product" means a brand or
7 generic opioid analgesic drug product approved by the federal food and
8 drug administration with abuse-deterrence labeling claims indicating its
9 abuse-deterrent properties are expected to deter or reduce its abuse.
10 (3) "Cost-sharing" means any coverage limit, copayment, coinsurance,
11 deductible or other out-of-pocket patient expense requirements.
12 § 2. This act shall take effect on the one hundred twentieth day after
13 it shall have become a law, and shall apply to all policies and
14 contracts issued, renewed, modified, altered or amended on or after such
15 date.
