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.