S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   4667
 
                        2021-2022 Regular Sessions
 
                           I N  A S S E M B L Y
 
                             February 4, 2021
                                ___________
 
 Introduced by M. of A. SAYEGH -- read once and referred to the Committee
   on Insurance
 
 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:
 
   Section 1. Section 273 of the public health law is amended by adding a
 new subdivision 11 to read as follows:
   11.  ANY PRIOR AUTHORIZATION REQUIREMENTS FOR OPIOID ANALGESIC AND ANY
 SERVICE DENIALS MADE PURSUANT THERETO SHALL NOT REQUIRE  USE  OF  OPIOID
 ANALGESIC   DRUG  PRODUCTS  WITHOUT  ABUSE-DETERRENT  PROPERTIES  BEFORE
 AUTHORIZING THE USE OF ABUSE-DETERRENT OPIOID ANALGESIC DRUG PRODUCTS.
   § 2. The insurance law is amended by adding a new  section  3216-a  to
 read as follows:
   § 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  ANALGESICS  DRUG PRODUCT PER OPIOID ANALGESICS 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.
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
              

                                                            LBD06823-01-1

 A. 4667                             2
 
   (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
 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.
   § 3. 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.