2014 -- H 7477

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LC004393

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     STATE OF RHODE ISLAND

IN GENERAL ASSEMBLY

JANUARY SESSION, A.D. 2014

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A N   A C T

RELATING TO INSURANCE - ACCESS TO ABUSE-DETERRENT PAIN MEDICATIONS

     Introduced By: Representatives Ferri, McNamara, Messier, Naughton, and Ajello

     Date Introduced: February 13, 2014

     Referred To: House Corporations

     It is enacted by the General Assembly as follows:

     SECTION 1. Chapter 27-18 of the General Laws entitled "Accident and Sickness

Insurance Policies" is hereby amended by adding thereto the following section:

     4 27-18-82. Access to Abuse-Deterrent Pain Medications.-- (a) Every individual or

group health insurance contract or every individual or group hospital or medical expense

insurance policy, plan, or group policy issued for delivery, or renewed in this state on or after the

passage of this act that provides coverage for prescription drugs shall not require, as a condition

of coverage:

     (1) Use of an opioid drug not indicated by the United States Food and Drug

Administration (FDA) for the condition being treated prior to use of a non-opioid drug that is

approved by the FDA for the condition being treated; or

     (2) Use of a non-abuse-deterrent formulation prior to use of an abuse-deterrent

formulation for the treatment of pain.

     (b) For the purpose of this section:

     (1) "Abuse-deterrent formulation" means a drug used to treat pam that is considered to

have abuse-deterrent properties if the FDA determines there is sufficient evidence to support

abuse-deterrent claims based on published FDA guidance.

     (2) "Non-abuse-deterrent formulation" means a drug used to treat pain that is not

considered an abuse-deterrent formulation.

     (c) Health insurance contracts, plans or policies to which this section applies may require

an insured to use, prior to using a brand name prescription drug prescribed by a licensed

prescriber a therapeutically equivalent generic drug, unless, pursuant to §§ 5-19.1-19, 5-37-18.1

and 21-31-15(b), the prescriber indicates "brand name necessary" on the prescription form, or if

the prescriber gives oral direction to that effect to the dispensing pharmacist.

     SECTION 2. Chapter 27-19 of the General Laws entitled "Nonprofit Hospital Service

Corporations" is hereby amended by adding thereto the following section:

     27-19-73. Access to Abuse-Deterrent Pain Medications.-- (a) Every individual or

group health insurance contract or every individual or group hospital or medical expense

insurance policy, plan, or group policy issued for delivery, or renewed in this state on or after the

passage of this act that provides coverage for prescription drugs shall not require, as a condition

of coverage:

     (1) Use of an opioid drug not indicated by the United States Food and Drug

Administration (FDA) for the condition being treated prior to use of a non-opioid drug that is

approved by the FDA for the condition being treated; or

     (2) Use of a non-abuse-deterrent formulation prior to use of an abuse-deterrent

formulation for the treatment of pain.

     (b) For the purpose of this section:

     (1) "Abuse-deterrent formulation" means a drug used to treat pain that is considered to

have abuse-deterrent properties if the FDA determines there is sufficient evidence to support

abuse-deterrent claims based on published FDA guidance.

     (2) "Non-abuse-deterrent formulation" means a drug used to treat pain that is not

considered an abuse-deterrent formulation.

     (c) Health insurance contracts, plans or policies to which this section applies may require

an insured to use, prior to using a brand name prescription drug prescribed by a licensed

prescriber, a therapeutically equivalent generic drug, unless pursuant to §§ 5-19.1-19, 5-37-18.1

and 21-31-15(b), the prescriber indicates "brand name necessary" on the prescription form, or if

the prescriber gives oral direction to that effect to the dispensing pharmacist.

     SECTION 3. Chapter 27-20 of the General Laws entitled "Nonprofit Medical Service

Corporations" is hereby amended by adding thereto the following section:

     27-20-69. Access to Abuse-Deterrent Pain Medications. -- (a) Every individual or

group health insurance contract, or every individual or group hospital or medical expense

insurance policy, plan, or group policy issued for delivery, or renewed in this state on or after the

passage of this act that provides coverage for prescription drugs shall not require, as a condition

of coverage:

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     (1) Use of an opioid drug not indicated by the United States Food and Drug

Administration (FDA) for the condition being treated prior to use of a non-opioid drug that is

approved by the FDA for the condition being treated; or

     (2) Use of a non-abuse-deterrent formulation prior to use of an abuse-deterrent

formulation for the treatment of pain.

     (b) For the purpose of this section:

     (1) "Abuse-deterrent formulation" means a drug used to treat pain that is considered to

have abuse-deterrent properties if the FDA determines there is sufficient evidence to support

abuse-deterrent claims based on published FDA guidance.

     (2) "Non-abuse-deterrent formulation" means a drug used to treat pain that is not

considered an abuse-deterrent formulation.

     (c) Health insurance contracts, plans or policies to which this section applies may require

an insured to use, prior to using a brand name prescription drug prescribed by a licensed

prescriber, a therapeutically equivalent generic drug, unless, pursuant to §§ 5-19.1-19, 5-3 7-18.1

and 21-31-15(b), the prescriber indicates "brand name necessary" on the prescription form, or if

the prescriber gives oral direction to that effect to the dispensing pharmacist.

     SECTION 4. Chapter 27-41 of the General Laws entitled "Health Maintenance

Organizations" is hereby amended by adding thereto the following section:

     27-41-86. Access to Abuse-Deterrent Pain Medications.-- (a) Every individual or

group health insurance contract, or every individual or group hospital or medical expense

insurance policy, plan, or group policy issued for delivery, or renewed in this state on or after the

passage of this act that provides coverage for prescription drugs shall not require, as a condition

of coverage:

     (1) Use of an opioid drug not indicated by the United States Food and Drug

Administration (FDA) for the condition being treated prior to use of a non-opioid drug that is

approved by the FDA for the condition being treated; or

     (2) Use of a non-abuse-deterrent formulation prior to use of an abuse-deterrent

formulation for the treatment of pain.

     (b) For the purpose of this section:

     (1) "Abuse-deterrent formulation" means a drug used to treat pain that is considered to

have abuse-deterrent properties if the FDA determines there is sufficient evidence to support

abuse-deterrent claims based on published FDA guidance.

     (2) "Non-abuse-deterrent formulation" means a drug used to treat pain that is not

considered an abuse-deterrent formulation.

LC004393 - Page 3 of 5

     (c) Health insurance contracts, plans or policies to which this section applies may require

an insured to use, prior to using a brand name prescription drug prescribed by a licensed

prescriber, a therapeutically equivalent generic drug, unless, pursuant to §§ 5-19.1-19, 5-37-18.1

and 21-31-15(b), the prescriber indicates "brand name necessary" on the prescription form, or if

the prescriber gives oral direction to that effect to the dispensing pharmacist.

     SECTION 5. This act shall take effect upon passage.

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EXPLANATION

BY THE LEGISLATIVE COUNCIL

OF

A N   A C T

RELATING TO INSURANCE - ACCESS TO ABUSE-DETERRENT PAIN MEDICATIONS

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     This act would prevent health insurance policies, plans or contracts that provide coverage

for prescription drugs from requiring a beneficiary to use an opioid drug not indicated by the

FDA for the condition being treated prior to the use of a non-opioid drug that is approved by the

FDA for the condition being treated, or to use a non-abuse-deterrent formulation prior to using an

abuse-deterrent formulation.

     This act would take effect upon passage.

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