2014 -- S 2534

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LC004655

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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: Senators Miller, Satchell, Picard, Goldin, and Jabour

     Date Introduced: February 27, 2014

     Referred To: Senate Health & Human Services

     It is enacted by the General Assembly as follows:

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

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

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

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

5

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

6

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

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of coverage:

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

9

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

10

approved by the FDA for the condition being treated; or

11

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

12

formulation for the treatment of pain.

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     (b) For the purpose of this section:

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

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

16

abuse-deterrent claims based on published FDA guidance.

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

18

considered an abuse-deterrent formulation.

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

 

1

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

2

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

3

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

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

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

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

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

8

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

9

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

10

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

11

of coverage:

12

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

13

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

14

approved by the FDA for the condition being treated; or

15

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

16

formulation for the treatment of pain.

17

     (b) For the purpose of this section:

18

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

19

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

20

abuse-deterrent claims based on published FDA guidance.

21

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

22

considered an abuse-deterrent formulation.

23

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

24

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

25

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

26

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

27

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

28

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

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

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

31

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

32

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

33

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

34

of coverage:

 

LC004655 - Page 2 of 4

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

2

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

3

approved by the FDA for the condition being treated; or

4

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

5

formulation for the treatment of pain.

6

     (b) For the purpose of this section:

7

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

8

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

9

abuse-deterrent claims based on published FDA guidance.

10

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

11

considered an abuse-deterrent formulation.

12

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

13

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

14

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

15

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

16

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

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

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

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

20

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

21

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

22

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

23

of coverage:

24

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

25

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

26

approved by the FDA for the condition being treated; or

27

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

28

formulation for the treatment of pain.

29

     (b) For the purpose of this section:

30

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

31

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

32

abuse-deterrent claims based on published FDA guidance.

33

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

34

considered an abuse-deterrent formulation.

 

LC004655 - Page 3 of 4

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

2

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

3

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

4

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

5

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

6

     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

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

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

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

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abuse-deterrent formulation.

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     This act would take effect upon passage.

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LC004655 - Page 5 of 4