S T A T E   O F   N E W   Y O R K
________________________________________________________________________

                                  10478

                          I N  A S S E M B L Y

                              May 27, 2016
                               ___________

Introduced by M. of A. CUSICK -- read once and referred 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:
  S 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
CONDITIONS, WHETHER IN IMMEDIATE RELEASE OR EXTENDED LONG ACTING RELEASE

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
              

                                                           LBD14477-04-6

A. 10478                            2

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.
  S 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.