Prohibits certain insurance policies from requiring prior authorization for buprenorphine products, methadone and long acting injectable naltrexone for detoxification or maintenance treatment of substance use disorders.
NEW YORK STATE ASSEMBLY MEMORANDUM IN SUPPORT OF LEGISLATION submitted in accordance with Assembly Rule III, Sec 1(f)
BILL NUMBER: A2904
SPONSOR: Quart TITLE OF BILL:
An act to amend the insurance law, in relation to prohibiting certain
insurance policies from requiring prior authorization for certain medi-
cations used in the treatment of substance use disorders; and to repeal
certain provisions of such law relating thereto
PURPOSE OR GENERAL IDEA OF BILL:
To ensure uniformity across all health insurance plan policies regarding
reasonable patient access to medication assisted treatment for substance
abuse disorders
SUMMARY OF SPECIFIC PROVISIONS:
Section 1 repeals subdivision 31-a of section 3216 of the insurance law
and replaces it with a new subdivision to require health insurers to
provide patient access, without prior authorization requirements, for
initial and renewal prescriptions for buprenorphine and long-acting
injectable naltrexone for the treatment of substance abuse disorders.
Section 2 repeals paragraphs 7-a and 7-b of subsection (1) of section
3221 of the insurance law and adds a new paragraph 7-a to require health
insurers to provide patient access, without prior authorization require-
ments, for initial and renewal prescriptions for buprenorphine and long-
acting injectable naltrexone for the treatment of substance abuse disor-
ders.
Section 3 repeals subsections (1-1) and (1-2) of section 4303 of the
insurance law and adds a new subsection (1-1) to require health insurers
to provide patient access, without prior authorization requirements, for
initial and renewal prescriptions for buprenorphine and long-acting
injectable naltrexone for the treatment of substance abuse disorders.
Section 4 provides that this act will take effect on the 60th day after
enactment.
JUSTIFICATION:
New York is experiencing an unprecedented heroin and opioid epidemic
that is ravaging communities across the state. According to the New York
State Comptroller's Office, New York has experienced an increase in
death rates due to opioid and heroin addiction that outpaces almost any
other state where data is available.
This bill builds upon measures enacted in 2016 to improve access to
health insurance coverage for substance abuse treatment, including medi-
cation assisted treatment. In 2016, prior authorization requirements
were removed for buprenorphine and long- acting injectable naltrexone in
the Medicaid program. The purpose of this bill is to establish parity
for all consumers by ensuring that addicted persons with commercial
insurance coverage can access medication assisted treatment as
prescribed by their health care providers without unnecessary barriers.
PRIOR LEGISLATIVE HISTORY:
2017-2018: A7979 passed Assembly
FISCAL IMPLICATIONS:
None
EFFECTIVE DATE:
Sixty days after enactment
STATE OF NEW YORK
________________________________________________________________________
2904
2019-2020 Regular Sessions
IN ASSEMBLY
January 28, 2019
___________
Introduced by M. of A. QUART -- read once and referred to the Committee
on Insurance
AN ACT to amend the insurance law, in relation to prohibiting certain
insurance policies from requiring prior authorization for certain
medications used in the treatment of substance use disorders; and to
repeal certain provisions of such law relating thereto
The People of the State of New York, represented in Senate and Assem-bly, do enact as follows:
1 Section 1. Paragraph 31-a of subsection (i) of section 3216 of the
2 insurance law is REPEALED and a new paragraph 31-a is added to read as
3 follows:
4 (31-a) (A) No policy that provides medical, major medical or similar
5 comprehensive-type coverage and provides coverage for prescription drugs
6 for medication for the treatment of a substance use disorder shall
7 require prior authorization for an initial or renewal prescription for
8 all buprenorphine products, methadone or long acting injectable naltrex-
9 one for detoxification or maintenance treatment of a substance use
10 disorder except where otherwise prohibited by law.
11 (B) Coverage provided under this paragraph may be subject to copay-
12 ments, coinsurance, and annual deductibles that are consistent with
13 those imposed on other benefits within the policy.
14 § 2. Paragraphs 7-a and 7-b of subsection (l) of section 3221 of the
15 insurance law are REPEALED and a new paragraph 7-a is added to read as
16 follows:
17 (7-a) (A) Every policy that provides medical, major medical or similar
18 comprehensive-type large group coverage shall provide immediate coverage
19 for all buprenorphine products, methadone or long acting injectable
20 naltrexone without prior authorization for the detoxification or mainte-
21 nance treatment of a substance use disorder.
EXPLANATION--Matter in italics (underscored) is new; matter in brackets
[] is old law to be omitted.
LBD01428-01-9
A. 2904 2
1 (B) Coverage provided under this paragraph may be subject to copay-
2 ments, coinsurance, and annual deductibles that are consistent with
3 those imposed on other benefits within the policy.
4 § 3. Subsections (l-1) and (l-2) of section 4303 of the insurance law
5 are REPEALED and a new subsection (l-1) is added to read as follows:
6 (l-1) (A) Every contract that provides medical, major medical, or
7 similar comprehensive-type large group coverage shall provide immediate
8 coverage for all buprenorphine products, methadone or long acting
9 injectable naltrexone without prior authorization for the detoxification
10 or maintenance treatment of a substance use disorder.
11 (B) Coverage provided under this paragraph may be subject to copay-
12 ments, coinsurance, and annual deductibles that are consistent with
13 those imposed on other benefits within the policy.
14 § 4. This act shall take effect on the sixtieth day after it shall
15 have become a law.
