HP0638, LD 919, item 1, An Act To Provide Access to Opioid Analgesics with Abuse-deterrent Properties

An Act To Provide Access to Opioid Analgesics with Abuse-deterrent Properties

Be it enacted by the People of the State of Maine as follows:

Sec. 1. 24-A MRSA §4320-J is enacted to read:

§ 4320-J. Coverage for abuse-deterrent opioid analgesic drug products

1. Definitions. As used in this section, unless the context otherwise indicates, the following terms have the following meanings.

A. "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-deterrent 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 expense associated with a health plan.

C. "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.

2. Required coverage. A carrier offering a health plan in this State shall provide coverage for abuse-deterrent opioid analgesic drug products as preferred drugs on any formulary, preferred drug list or other list of drugs used by the carrier. Any cost sharing imposed by a carrier for coverage of abuse-deterrent opioid analgesic drug products may not exceed the lowest cost-sharing level applied to other prescription drugs. An increase in enrollee cost sharing or other disincentives for prescribers or dispensers to achieve compliance with this section may not be implemented.

3. Utilization management. The following requirements apply.

A. Any prior authorization requirements or other utilization review measures for opioid analgesic drug products on the market and any denials of coverage made pursuant to those measures may not require use of opioid analgesic drug products first in order to obtain abuse-deterrent opioid analgesic drug products.

B. This section may not be construed to prevent a carrier from applying prior authorization requirements to abuse-deterrent opioid analgesic drug products as long as such requirements are applied to opioid analgesic drug products in the same manner.

Sec. 2. Application. The requirements of this Act apply to all policies, contracts and certificates executed, delivered, issued for delivery, continued or renewed in this State on or after January 1, 2016. For purposes of this Act, all contracts are deemed to be renewed no later than the next yearly anniversary of the contract date.

summary

This bill requires all health insurance carriers offering individual and group health plans to provide coverage for abuse-deterrent opioid analgesic drug products as preferred drugs on any formulary, preferred drug list or other list of drugs used by the carrier. The bill applies to all policies and contracts issued or renewed on or after January 1, 2016.

HP0638 LD 919	Session - 127th Maine Legislature		LR 1724 Item 1
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