STATE OF NEW YORK
________________________________________________________________________
6397
2019-2020 Regular Sessions
IN SENATE
June 7, 2019
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Introduced by Sen. CARLUCCI -- read twice and ordered printed, and when
printed to be committed to the Committee on Rules
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:
1 Section 1. Section 273 of the public health law is amended by adding a
2 new subdivision 11 to read as follows:
3 11. Any prior authorization requirements for opioid analgesic and any
4 service denials made pursuant thereto shall not require use of opioid
5 analgesic drug products without abuse-deterrent properties before
6 authorizing the use of abuse-deterrent opioid analgesic drug products.
7 § 2. The insurance law is amended by adding a new section 3216-a to
8 read as follows:
9 § 3216-a. Access to abuse-deterrent opioid medications. (a) An insur-
10 ance carrier or health plan shall provide coverage on its formulary,
11 drug list or other lists of similar construct for at least one abuse-
12 deterrent opioid analgesics drug product per opioid analgesics active
13 ingredient.
14 (1) Cost-sharing for brand name abuse-deterrent opioid analgesic drug
15 products covered pursuant to this section shall not exceed the lowest
16 cost-sharing level applied to brand name non-abuse deterrent opioid
17 drugs covered under the applicable health plan or policy.
18 (2) Cost-sharing for generic abuse-deterrent opioid analgesic drug
19 products covered pursuant to this section shall not exceed the lowest
20 cost-sharing level applied to generic non-abuse deterrent opioid drugs
21 covered under the applicable health plan or policy.
22 (3) An increase in patient cost-sharing or disincentives for prescri-
23 bers or dispensers shall not be allowed to achieve compliance with this
24 section.
EXPLANATION--Matter in italics (underscored) is new; matter in brackets
[] is old law to be omitted.
LBD13268-01-9
S. 6397 2
1 (b) Any prior-authorization requirements or other utilization review
2 measures for opioid analgesics, and any service denials made pursuant
3 thereto, shall not require use of opioid analgesic drug products without
4 abuse-deterrent properties in order to access abuse-deterrent opioid
5 analgesic drug products.
6 (c) Definitions. As used in this section:
7 (1) "Opioid analgesic drug product" means a drug in the opioid anal-
8 gesic drug class prescribed to treat moderate to severe pain or other
9 conditions, whether in immediate release or extended long acting release
10 form and whether or not combined with other drug substances to form a
11 single drug product or other dosage form.
12 (2) "Abuse deterrent opioid analgesic drug product" means a brand or
13 generic opioid analgesic drug product approved by the federal food and
14 drug administration with abuse-deterrence labeling claims indicating its
15 abuse-deterrent properties are expected to deter or reduce its abuse.
16 (3) "Cost-sharing" means any coverage limit, copayment, coinsurance,
17 deductible or other out-of-pocket patient expense requirements.
18 § 3. This act shall take effect on the one hundred twentieth day after
19 it shall have become a law, and shall apply to all policies and
20 contracts issued, renewed, modified, altered or amended on or after such
21 date.
