S3022

	2026 -- S 3022
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	LC005923
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	STATE OF RHODE ISLAND
	IN GENERAL ASSEMBLY
	JANUARY SESSION, A.D. 2026
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	A N A C T
	RELATING TO INSURANCE -- ACCIDENT AND SICKNESS INSURANCE POLICIES

	Introduced By: Senators Bissaillon, Murray, DiMario, and DiPalma
	Date Introduced: March 05, 2026
	Referred To: Senate Health & Human Services
	It is enacted by the General Assembly as follows:
1	SECTION 1. Chapter 27-18 of the General Laws entitled "Accident and Sickness Insurance
2	Policies" is hereby amended by adding thereto the following section:
3	27-18-96. Access to pain management services.
4	(a) Every individual or group health insurance contract, plan, or policy that provides
5	prescription coverage and that is delivered, issued for delivery, prescribed, or renewed in this state
6	on or after January 1, 2027, shall develop a plan to provide adequate coverage of and access to a
7	broad spectrum of pain management services including, but not limited to, nonopioid, nonnarcotic
8	medication for pain management and nonmedication pain management services that serve as
9	alternatives to the prescribing of opioid or narcotic drugs in accordance with guidelines developed
10	by the office of the health insurance commissioner.
11	(b)(1) Approval by health insurance commissioner. Every individual or group health
12	insurance carrier shall file a plan required under subsection (a) of this section with the
13	commissioner for approval. In its review, the commissioner shall consider the adequacy of access
14	to a broad spectrum of pain management services under the plan and whether any policies adopted
15	by the carrier may create unduly preferential coverage of and access to prescribed opioids for pain
16	management without consideration of other pain management services.
17	(2) No individual or group health insurance contract, plan, or policy that provides
18	prescription coverage and that is delivered, issued for delivery, prescribed, or renewed in this state
19	on or after January 1, 2027 shall apply any utilization review, including without limitation, prior

1	authorization or step therapy protocols, for clinically appropriate nonopioid prescription drugs
2	approved by the United States Food and Drug Administration for the treatment or management of
3	moderate to severe pain, that is more restrictive or extensive than the least restrictive or extensive
4	utilization review applicable to any clinically appropriate opioid or narcotic drug.
5	(c) Information for enrollees. Every individual or group health insurance carrier shall
6	distribute educational materials to network providers about a pain management access plan under
7	subsection (a) of this section and post information about the pain management access plan on the
8	carrier's publicly accessible website.
9	SECTION 2. Chapter 27-19 of the General Laws entitled "Nonprofit Hospital Service
10	Corporations" is hereby amended by adding thereto the following section:
11	27-19-88. Access to pain management services.
12	(a) Every individual or group health insurance contract, plan, or policy that provides
13	prescription coverage and that is delivered, issued for delivery, prescribed, or renewed in this state
14	on or after January 1, 2027, shall develop a plan to provide adequate coverage of and access to a
15	broad spectrum of pain management services including, but not limited to, nonopioid, nonnarcotic
16	medication for pain management and nonmedication pain management services that serve as
17	alternatives to the prescribing of opioid or narcotic drugs in accordance with guidelines developed
18	by the office of the health insurance commissioner.
19	(b)(1) Approval by health insurance commissioner. Every individual or group health
20	insurance carrier shall file a plan required under subsection (a) of this section with the
21	commissioner for approval. In its review, the commissioner shall consider the adequacy of access
22	to a broad spectrum of pain management services under the plan and whether any policies adopted
23	by the carrier may create unduly preferential coverage of and access to prescribed opioids for pain
24	management without consideration of other pain management services.
25	(2) No individual or group health insurance contract, plan, or policy that provides
26	prescription coverage and that is delivered, issued for delivery, prescribed, or renewed in this state
27	on or after January 1, 2027 shall apply any utilization review, including without limitation, prior
28	authorization or step therapy protocols, for clinically appropriate nonopioid prescription drugs
29	approved by the United States Food and Drug Administration for the treatment or management of
30	moderate to severe pain, that is more restrictive or extensive than the least restrictive or extensive
31	utilization review applicable to any clinically appropriate opioid or narcotic drug.
32	(c) Information for enrollees. Every individual or group health insurance carrier shall
33	distribute educational materials to network providers about a pain management access plan under
34	subsection (a) of this section and post information about the pain management access plan on the
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1	carrier's publicly accessible website.
2	SECTION 3. Chapter 27-20 of the General Laws entitled "Nonprofit Medical Service
3	Corporations" is hereby amended by adding thereto the following section:
4	27-20-84. Access to pain management services.
5	(a) Every individual or group health insurance contract, plan, or policy that provides
6	prescription coverage and that is delivered, issued for delivery, prescribed, or renewed in this state
7	on or after January 1, 2027, shall develop a plan to provide adequate coverage of and access to a
8	broad spectrum of pain management services including, but not limited to, nonopioid, nonnarcotic
9	medication for pain management and nonmedication pain management services that serve as
10	alternatives to the prescribing of opioid or narcotic drugs in accordance with guidelines developed
11	by the office of the health insurance commissioner.
12	(b)(1) Approval by health insurance commissioner. Every individual or group health
13	insurance carrier shall file a plan required under subsection (a) of this section with the
14	commissioner for approval. In its review, the commissioner shall consider the adequacy of access
15	to a broad spectrum of pain management services under the plan and whether any policies adopted
16	by the carrier may create unduly preferential coverage of and access to prescribed opioids for pain
17	management without consideration of other pain management services.
18	(2) No individual or group health insurance contract, plan, or policy that provides
19	prescription coverage and that is delivered, issued for delivery, prescribed, or renewed in this state
20	on or after January 1, 2027 shall apply any utilization review, including without limitation, prior
21	authorization or step therapy protocols, for clinically appropriate nonopioid prescription drugs
22	approved by the United States Food and Drug Administration for the treatment or management of
23	moderate to severe pain, that is more restrictive or extensive than the least restrictive or extensive
24	utilization review applicable to any clinically appropriate opioid or narcotic drug.
25	(c) Information for enrollees. Every individual or group health insurance carrier shall
26	distribute educational materials to network providers about a pain management access plan under
27	subsection (a) of this section and post information about the pain management access plan on the
28	carrier's publicly accessible website.
29	SECTION 4. Chapter 27-41 of the General Laws entitled "Health Maintenance
30	Organizations" is hereby amended by adding thereto the following section:
31	27-41-101. Access to pain management services.
32	(a) Every individual or group health insurance contract, plan, or policy that provides
33	prescription coverage and that is delivered, issued for delivery, prescribed, or renewed in this state
34	on or after January 1, 2027, shall develop a plan to provide adequate coverage of and access to a
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1	broad spectrum of pain management services including, but not limited to, nonopioid, nonnarcotic
2	medication for pain management and nonmedication pain management services that serve as
3	alternatives to the prescribing of opioid or narcotic drugs in accordance with guidelines developed
4	by the office of the health insurance commissioner.
5	(b)(1) Approval by health insurance commissioner. Every individual or group health
6	insurance carrier shall file a plan required under subsection (a) of this section with the
7	commissioner for approval. In its review, the commissioner shall consider the adequacy of access
8	to a broad spectrum of pain management services under the plan and whether any policies adopted
9	by the carrier may create unduly preferential coverage of and access to prescribed opioids for pain
10	management without consideration of other pain management services.
11	(2) No individual or group health insurance contract, plan, or policy that provides
12	prescription coverage and that is delivered, issued for delivery, prescribed, or renewed in this state
13	on or after January 1, 2027 shall apply any utilization review, including without limitation, prior
14	authorization or step therapy protocols, for clinically appropriate nonopioid prescription drugs
15	approved by the United States Food and Drug Administration for the treatment or management of
16	moderate to severe pain, that is more restrictive or extensive than the least restrictive or extensive
17	utilization review applicable to any clinically appropriate opioid or narcotic drug.
18	(c) Information for enrollees. Every individual or group health insurance carrier shall
19	distribute educational materials to network providers about a pain management access plan under
20	subsection (a) of this section and post information about the pain management access plan on the
21	carrier's publicly accessible website.
22	SECTION 5. Chapter 40-21 of the General Laws entitled "Medical Assistance —
23	Prescription Drugs" is hereby amended by adding thereto the following section:
24	40-21-4. Access to nonopioid pain treatment.
25	(a) The Rhode Island medical assistance program, as defined under chapter 8 of this title,
26	and any contract between the Rhode Island medical assistance program and a managed care
27	organization, shall not apply any utilization review, including without limitation prior authorization
28	or step therapy protocols, for clinically appropriate nonopioid prescription drugs approved by the
29	United States Food and Drug Administration for the treatment or management of moderate to
30	severe pain, that is more restrictive or extensive than the least restrictive or extensive utilization
31	review applicable to any clinically appropriate opioid or narcotic drug.
32	(b) The Rhode Island medical assistance program shall require, through amending current
33	and future medical assistance managed care contracts, that managed care organizations meet the
34	provisions of this section.
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1	(c) This section applies to all policies, contracts, and plans executed, delivered, issued for
2	delivery, continued or renewed in this state on or after January 1, 2027.
3	SECTION 6. 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 -- ACCIDENT AND SICKNESS INSURANCE POLICIES
	***
1	This act would require insurers to develop plans for coverage and access to nonnarcotic,
2	nonopioid and nonmedication pain management for moderate to severe pain. This act would further
3	restrict utilization review for nonopioid drugs.
4	This act would take effect upon passage.
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	LC005923
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