NY State Senate Bill 2019-S5535

Senate Bill S5535

2019-2020 Legislative Session

Requires insurers providing coverage of prescription drugs for opioid addiction, to provide coverage of such prescription drugs prescribed for the treatment of substance abuse disorder

download bill text pdf

Archive: Last Bill Status - In Senate Committee Insurance Committee

Introduced
- In Committee Assembly
- In Committee Senate
- On Floor Calendar Assembly
- On Floor Calendar Senate
- Passed Assembly
- Passed Senate
Delivered to Governor
Signed By Governor

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Actions

View Actions

	Assembly Actions - Lowercase Senate Actions - UPPERCASE
Jan 08, 2020	referred to insurance
May 06, 2019	referred to insurance

2019-S5535 (ACTIVE) - Details

See Assembly Version of this Bill:: A294
Current Committee:: Senate Insurance
Law Section:: Insurance Law
Laws Affected:: Amd §§3216, 3221 & 4303, Ins L
Versions Introduced in Other Legislative Sessions:: 2015-2016: A10237
2017-2018: S7905, A4899

2019-S5535 (ACTIVE) - Summary

Requires insurers providing coverage of prescription drugs for opioid addiction, to provide coverage of such prescription drugs prescribed for the treatment of substance abuse disorder.

2019-S5535 (ACTIVE) - Sponsor Memo

                                
 
BILL NUMBER: S5535

SPONSOR: HARCKHAM
 
TITLE OF BILL:  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

 
PURPOSE:

This bill ensures that patients suffering from drug and alcohol depend-
ency receive appropriate care, by requiring that health insurers provide
coverage of opioid addiction medications during the entire period such
medications are proscribed.

 
SUMMARY OF PROVISIONS:

Section one amends subsection (i) of section 3216 of the insurance law.

Section two amends subsection (1) of section 3221 of the insurance law.

Section three adds a new subsection to section 4303 of the insurance
law.

Section four sets forth the effective date.

 
JUSTIFICATION:

Opioid use has grown by epidemic proportions in recent years. There is
significant need for accessible treatment options for individuals seek-
ing medical treatment for addiction. However, in some reported
instances, insurance companies have denied or sought to deny continued
coverage for buprenorphine and other medications prescribed to treat
opiate addiction. Insurance companies should not deny treatment options
for opioid addiction recovery as prescribed by a doctor treating a
patient in recovery, nor should insurance companies dictate to any
doctor or patient a specified amount of time that a patient can or
should remain on such medication.

This legislation would ensure that patients suffering from drug and
alcohol dependency receive appropriate care by prohibiting insurance
companies from denying coverage of medication for treatment for opioid
addiction during the entire period of time the medications and drugs are
prescribed for such treatment by and authorized prescriber.

 
LEGISLATIVE HISTORY:

2017-18: A.4899-C - Ordered to Third Reading Calendar; S.7905-A -
Referred to Insurance
2015-16: A.10237 - Referred to Insurance

 
FISCAL IMPLICATIONS:

Undetermined

 
EFFECTIVE DATE:
This bill shall take effect immediately.

2019-S5535 (ACTIVE) - Bill Text download pdf

                            
 
                     S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   5535
 
                        2019-2020 Regular Sessions
 
                             I N  S E N A T E
 
                                May 6, 2019
                                ___________
 
 Introduced  by Sen. HARCKHAM -- 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  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
 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.
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.

                                                            LBD01571-02-9

 S. 5535                             2
 
   (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.

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