Requires insurers providing coverage of prescription drugs for opioid addiction, to provide coverage of such prescription drugs prescribed for the treatment of substance abuse disorder.
NEW YORK STATE ASSEMBLY MEMORANDUM IN SUPPORT OF LEGISLATION submitted in accordance with Assembly Rule III, Sec 1(f)
 
BILL NUMBER: A4899C
SPONSOR: Rosenthal L
 
TITLE OF BILL:
An act to amend the insurance law, in relation to requiring health
insurers to provide coverage of opioid addiction prescription drugs
prescribed for the treatment of substance abuse disorder
 
PURPOSE:
This bill ensures that patients suffering from drug and alcohol depend-
ency receive appropriate care, by requiring that health insurers to
provide overage, without prior authorization, for an initial or renewal
prescription for drugs prescribed for the treatment of substance abuse
disorder
 
SUMMARY OF SPECIFIC PROVISIONS:
Section one amends subsection (i) of section 3216 of the insurance law
to provide that every policy providing medical, major medical or similar
comprehensive-type coverage, or coverage for prescription drugs must
provide coverage, without prior authorization, for an initial or renewal
prescription for prescription drugs prescribed for the treatment of
substance use disorder.
Section two amends subsection (1) of section 3221 of the insurance law
to provide that every policy providing medical, major medical or similar
comprehensive-type coverage, or coverage for prescription drugs must
provide coverage, without prior authorization, for an initial or renewal
prescription for prescription drugs prescribed for the treatment of
substance use disorder.
Section three adds a new subsection to section 4303 of the insurance Law
to provide that every contract that provides medical, major medical or
similar comprehensive-type coverage, or coverage for prescription drugs
must provide coverage, without prior authorization, for an initial or
renewal prescription for prescription drugs prescribed for the treatment
of substance use disorder.
Section four sets forth the effective date.
 
JUSTIFICATION:
Opioid use has grown by epidemic proportions in recent years. There is
significant need for accessible treatment options for individuals seek-
ing medical treatment for addiction. However, in some reported
instances, insurance companies have denied or sought to deny continued
coverage for buprenorphine and other medications prescribed to treat
opiate addiction. Insurance companies should not deny coverage for
treatment options for opioid addiction recovery as prescribed by a
doctor treating a patient in recovery.
This legislation would ensure that patients suffering from drug and
alcohol dependency receive appropriate care by prohibiting insurance
companies from denying coverage of medication for treatment of substance
use disorder for an initial or renewal prescription for prescription
drugs prescribed for the treatment of substance use disorder.
 
LEGISLATIVE HISTORY:
2017: A.4899 - Referred to Insurance
2015-16: A.10237 - Referred to Insurance
 
FISCAL IMPLICATIONS:
Undetermined.
 
EFFECTIVE DATE:
This bill shall take effect immediately.
STATE OF NEW YORK
________________________________________________________________________
4899--C
2017-2018 Regular Sessions
IN ASSEMBLY
February 6, 2017
___________
Introduced by M. of A. L. ROSENTHAL, BRINDISI, HUNTER, GALEF -- read
once and referred to the Committee on Insurance -- recommitted to the
Committee on Insurance in accordance with Assembly Rule 3, sec. 2 --
committee discharged, bill amended, ordered reprinted as amended and
recommitted to said committee -- again reported from said committee
with amendments, ordered reprinted as amended and recommitted to said
committee -- reported and referred to the Committee on Codes --
reported and referred to the Committee on Ways and Means -- committee
discharged, bill amended, ordered reprinted as amended and recommitted
to said committee
AN ACT to amend the insurance law, in relation to requiring health
insurers to provide coverage of opioid addiction prescription drugs
prescribed for the treatment of substance abuse disorder
The People of the State of New York, represented in Senate and Assem-bly, do enact as follows:
1 Section 1. Subsection (i) of section 3216 of the insurance law is
2 amended by adding a new paragraph 35 to read as follows:
3 (35)(A) Every policy that provides medical, major medical or similar
4 comprehensive-type coverage, or coverage for prescription drugs must
5 provide coverage, without prior authorization or step therapy, for an
6 initial or renewal prescription for prescription drugs prescribed for
7 the treatment of substance abuse disorder suffered by a covered person
8 with an addiction to opioids.
9 (B) Coverage provided under this paragraph may be subject to annual
10 deductibles and co-insurance as deemed appropriate by the superintendent
11 and that are consistent with those imposed on other benefits within a
12 given policy.
13 (C) For the purposes of this paragraph, "prescription drugs prescribed
14 for the treatment of substance abuse disorder" shall mean medications
15 and prescription drugs approved by the food and drug administration for
16 the detoxification or maintenance treatment of substance use disorder.
EXPLANATION--Matter in italics (underscored) is new; matter in brackets
[] is old law to be omitted.
LBD05152-05-8
A. 4899--C 2
1 § 2. Subsection (l) of section 3221 of the insurance law is amended by
2 adding a new paragraph 7-c to read as follows:
3 (7-c)(A) Every policy that provides medical, major medical or similar
4 comprehensive-type coverage, or coverage for prescription drugs must
5 provide coverage, without prior authorization or step therapy, for an
6 initial or renewal prescription for prescription drugs prescribed for
7 the treatment of substance abuse disorder suffered by a covered person
8 with an addiction to opioids.
9 (B) Coverage provided under this paragraph may be subject to annual
10 deductibles and co-insurance as deemed appropriate by the superintendent
11 and that are consistent with those imposed on other benefits within a
12 given policy.
13 (C) For the purposes of this paragraph, "prescription drugs prescribed
14 for the treatment of substance abuse disorder" shall mean medications
15 and prescription drugs approved by the food and drug administration for
16 the detoxification or maintenance treatment of substance use disorder.
17 § 3. Section 4303 of the insurance law is amended by adding a new
18 subsection (l-3) to read as follows:
19 (l-3) Every contract that provides medical, major medical or similar
20 comprehensive-type coverage, or coverage for prescription drugs must
21 provide coverage, without prior authorization or step therapy, for an
22 initial or renewal prescription for prescription drugs prescribed for
23 the treatment of substance abuse disorder suffered by a covered person
24 with an addiction to opioids. Coverage provided under this subsection
25 may be subject to annual deductibles and co-insurance as deemed appro-
26 priate by the superintendent and that are consistent with those imposed
27 on other benefits within a given contract. For the purposes of this
28 subsection, "prescription drugs prescribed for the treatment of
29 substance abuse disorder" shall mean medications and prescription drugs
30 approved by the food and drug administration for the detoxification or
31 maintenance treatment of substance use disorder.
32 § 4. This act shall take effect immediately.