S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                    62
 
                        2023-2024 Regular Sessions
 
                           I N  A S S E M B L Y
 
                                (PREFILED)
 
                              January 4, 2023
                                ___________
 
 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.

  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
                                                            LBD01769-01-3
 A. 62                               2
              

 
   (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
 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.