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:

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

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by adding thereto the following chapter:

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CHAPTER 81

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ACCESS TO OPIOID ANALGESICS WITH ABUSE-DETERRENT PROPERTIES

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

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

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welfare of the state.

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

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

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

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more than quadrupled since 1999.

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

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minimizing the potential for negative consequences from pain treatment.

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

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

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

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expected to result in a meaningful reduction in abuse.

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

 

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other out-of-pocket patient expense requirements.

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

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

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

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

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

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defined in chapter 41 of this title.

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

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

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

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

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self-insurance basis without the intervention of other entities.

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

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

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20 of this title.

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

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

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

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form a single drug product or dosage form.

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

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insurance as defined in chapter 18 of this title.

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

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

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

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by the following:

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

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

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drug products under the applicable health plan or policy.

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

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

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products under the applicable health plan or policy

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

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not be allowed to achieve compliance with this section.

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     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,

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

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patient to access abuse-deterrent opioid analgesic drug products.

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

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

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

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     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-

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

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plans cover non-abuse deterrent drugs formations.

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     This act would take effect upon passage.

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