2015 -- H 5219 SUBSTITUTE A

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     STATE OF RHODE ISLAND

IN GENERAL ASSEMBLY

JANUARY SESSION, A.D. 2015

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A N   A C T

RELATING TO INSURANCE - ACCESS TO OPIOID ANALGESICS WITH ABUSE-

DETERRENT PROPERTIES

     Introduced By: Representatives Edwards, Corvese, Amore, Shekarchi, and Ajello

     Date Introduced: January 29, 2015

     Referred To: House Corporations

     It is enacted by the General Assembly as follows:

     SECTION 1. Title 27 of the General Laws entitled "INSURANCE" is hereby amended

by adding thereto the following chapter:

CHAPTER 81

ACCESS TO OPIOID ANALGESICS WITH ABUSE-DETERRENT PROPERTIES

     27-81-1. Findings. -- The general assembly hereby finds and declares that:

     (1) The abuse of opioids is a serious problem that affects the health, social and economic

welfare of the state.

     (2) An estimated four million five hundred thousand (4,500,000) people in the United

States suffered from substance use disorders related to prescription opioid pain relievers in 2012.

     (3) The number of unintentional overdose deaths involving prescription pain relievers has

more than quadrupled since 1999.

     (4) It is imperative for people suffering from pain to get the relief they need while

minimizing the potential for negative consequences from pain treatment.

     21-81-2. Definitions.-- (a) "Abuse-deterrent opioid analgesic drug product" means a

brand or generic opioid analgesic drug product approved by the United States Food and Drug

Administration (FDA) with abuse-deterrence labeling claims that indicate the drug product is

expected to result in a meaningful reduction in abuse.

     (b) "Cost sharing" means any coverage limit, copayment, coinsurance, deductible, or

other out-of-pocket patient expense requirements.

     (c) "Healthcare services" means any services included in the furnishing to any individual

of medical, podiatric, or dental care, or hospitalization, or incident to the furnishing of that care or

hospitalization, and the furnishing to any person of any and all other services for the purpose of

preventing, alleviating, curing, or healing human illness, injury, or physical disability.

     (d) "Health maintenance organization" means a health maintenance organization as

defined in chapter 41 of this title.

     (e) "Insurer" means any person, firm or corporation offering and/or insuring health

services on a prepaid basis, including, but not limited to, a nonprofit service corporation, a health

maintenance organization, or an entity offering a policy of accident and sickness insurance. It

includes all persons, firms, or corporations providing health benefits coverage for employees on a

self-insurance basis without the intervention of other entities.

     (f) "Nonprofit service corporation" means a nonprofit hospital service corporation as

defined in chapter 19 of this title or a nonprofit medical service corporation as defined in chapter

20 of this title.

     (g) "Opioid analgesic drug product" means a drug product in the opioid analgesic drug

class prescribed to treat moderate to severe pain or other conditions, whether in immediate release

or extended release/long-acting form and whether or not combined with other drug substances to

form a single drug product or dosage form.

     (h) "Policy of accident and sickness insurance" means a policy of accident and sickness

insurance as defined in chapter 18 of this title.

     21-81-3. Coverage. -- (a) Each insurer that issues individual or group accident and

sickness insurance policies for health care services or provides health plans for health care

services shall provide coverage for abuse-deterrent opioid analgesic drug products and shall abide

by the following:

     (1) Cost sharing for brand name abuse-deterrent opioid analgesic drug products shall not

exceed the lowest cost-sharing level applied to brand name non-abuse-deterrent opioid analgesic

drug products under the applicable health plan or policy.

     (2) Cost sharing for generic abuse-deterrent opioid analgesic drug products shall not

exceed the lowest cost-sharing level applied to generic non-abuse-deterrent opioid analgesic drug

products under the applicable health plan or policy

     (3) An increase in patient cost sharing or disincentives for prescribers or dispensers shall

not be allowed to achieve compliance with this section.

     21-81-4. Utilization Management.-- (a) Any prior authorization requirements or other

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utilization review measures for opioid analgesics, and any service denials made pursuant thereto,

shall not require the use of non-abuse-deterrent opioid analgesic drug products in order for the

patient to access abuse-deterrent opioid analgesic drug products.

     (b) This section shall not be construed to prevent an insurer or health plan from applying

prior authorization requirements to abuse-deterrent opioid analgesic drug products, provided that

such requirements are applied to non-abuse-deterrent versions of that opioid.

     SECTION 2. 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 OPIOID ANALGESICS WITH ABUSE-

DETERRENT PROPERTIES

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     This act would require policies and plans issued by health insurers to cover abuse-

deterrent drug formulations of opioid analgesics in the same manner in which the policies and

plans cover non-abuse deterrent drugs formations.

     This act would take effect upon passage.

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