SB427 By Senator Bussman RFD Health and Human Services Rd 1 30-APR-15

SYNOPSIS: This bill would prohibit certain individual and group benefit plans executed or renewed in this state from requiring a covered individual to first use an opioid analgesic drug product without abuse-deterrence labeling claims before it will cover a prescription for an abuse-deterrent opioid analgesic drug product.

A BILL TO BE ENTITLED AN ACT

To provide that certain health benefit plans may not require an individual to use an opioid analgesic drug product without abuse-deterrence before covering a prescription for abuse-deterrent opioid analgesic drug products; and for those purposes to amend Sections 10A-20-6.16 and 27-21A-23, Code of Alabama 1965, as amended by Act 2014-324, 2014 Regular Session, relating to applicability of insurance laws to certain health service plans.

BE IT ENACTED BY THE LEGISLATURE OF ALABAMA:

Section 1. (a) For purposes of this section, the following words have the following meanings:

(1) ABUSE-DETERRENT OPIOID ANALGESIC DRUG PRODUCT. A brand or generic opioid analgesic drug product approved by the U.S. Food and Drug Administration (FDA) with abuse-deterrence labeling claims that indicate the drug product is expected to result in a meaningful reduction in abuse.

(2) COVERED INDIVIDUAL. An individual covered by either an individual health benefit plan or a group health benefit plan or the beneficiary of a government health program that offers comprehensive health insurance coverage or coverage for prescription drugs.

(3) HEALTH BENEFIT PLAN. An individual or group insurance policy that covers hospital, medical, or surgical expenses, health maintenance organizations, preferred provider organizations, medical service organizations, physician-hospital organizations, or any other person, firm, corporation, joint venture, or other similar business entity that pays for, purchases, or furnishes health care services to patients, insureds, or beneficiaries in this state. For the purposes of this act, a health benefit plan located or domiciled outside of the State of Alabama is deemed to be subject to this act if it receives, processes, adjudicates, pays, or denies claims for health care services submitted by or on behalf of patients, insureds, or beneficiaries who reside in the State of Alabama or who receive health care services in the State of Alabama. The term incudes, but is not limited to, entities created pursuant to Article 6, Chapter 20, Title 10A, Code of Alabama 1975.

(4) HEALTH INSURER. Any entity licensed or authorized to sell insurance policies offering a health benefit plan or an entity that provides health care coverage, including a pharmacy benefit manager that administers the pharmacy benefit for an otherwise covered entity.

(5) OPIOID ANALGESIC DRUG PRODUCT. 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.

(b) A health insurer or government program shall not require that a covered individual first use an opioid analgesic drug product without abuse-deterrence labeling claims before providing coverage for an abuse-deterrent opioid analgesic drug product.

(c) A health insurer or government program may not create disincentives for prescribers or dispensers to discourage the prescribing or dispensing of abuse-deterrent opioid analgesic drug products.

(d) This section shall not prohibit a health insurer or government program from using utilization review, including prior authorization, for abuse-deterrent opioid analgesic drug products provided that the same utilization review requirements are applied to all opioid analgesic drug products.Section 2. Sections 10A-20-6.16 and 27-21A-23, Code of Alabama 1975, as amended by Act 2014-324, 2014 Regular Session, are amended to read as follows:

§10A-20-6.16.

"(a) No statute of this state applying to insurance companies shall be applicable to any corporation organized under this article and amendments thereto or to any contract made by the corporation; except the corporation shall be subject to the following:

"(1) The provisions regarding annual premium tax to be paid by insurers on insurance premiums.

"(2) Chapter 55 of Title 27, regarding the prohibition of unfair discriminatory acts by insurers on the basis of an applicant's or insured's abuse status.

"(3) The Medicare Supplement Minimum Standards set forth in Article 2 of Chapter 19 of Title 27, and Long-Term Care Insurance Policy Minimum Standards set forth in Article 3 of Chapter 19 of Title 27.

"(4) Section 27-1-17, requiring insurers and health plans to pay health care providers in a timely manner.

"(5) Chapter 56 of Title 27, regarding the Access to Eye Care Act.

"(6) Rules promulgated by the Commissioner of Insurance pursuant to Sections 27-7-43 and 27-7-44.

"(7) Chapter 54 of Title 27.

"(8) Chapter 57 of Title 27, requiring coverage to be offered for the payment of colorectal cancer examinations for covered persons who are 50 years of age or older, or for covered persons who are less than 50 years of age and at high risk for colorectal cancer according to current American Cancer Society colorectal cancer screening guidelines.

"(9) Chapter 58 of Title 27, requiring that policies and contracts including coverage for prostate cancer early detection be offered, together with identification of associated costs.

"(10) Chapter 59 of Title 27, requiring that policies and contracts including coverage for chiropractic be offered, together with identification of associated costs.

"(11) Chapter 54A of Title 27, requiring that policies and contracts to offer coverage for certain treatment for Autism Spectrum Disorder under certain conditions.

"(12) Chapter 12A of Title 27.

"(13) Chapter 2B of Title 27.

"(14) Chapter 29 of Title 27.

"(15) Section 1 of the act adding this subdivision relating to abuse-deterrent opioid analgesic drug products.

"(b) The provisions in subsection (a) that require specific types of coverage to be offered or provided shall not apply when the corporation is administering a self-funded benefit plan or similar plan, fund, or program that it does not insure.

§27-21A-23.

"(a) Except as otherwise provided in this chapter, provisions of the insurance law and provisions of health care service plan laws shall not be applicable to any health maintenance organization granted a certificate of authority under this chapter. This provision shall not apply to an insurer or health care service plan licensed and regulated pursuant to the insurance law or the health care service plan laws of this state except with respect to its health maintenance organization activities authorized and regulated pursuant to this chapter.

"(b) Solicitation of enrollees by a health maintenance organization granted a certificate of authority shall not be construed to violate any provision of law relating to solicitation or advertising by health professionals.

"(c) Any health maintenance organization authorized under this chapter shall not be deemed to be practicing medicine and shall be exempt from the provisions of Section 34-24-310, et seq., relating to the practice of medicine.

"(d) No person participating in the arrangements of a health maintenance organization other than the actual provider of health care services or supplies directly to enrollees and their families shall be liable for negligence, misfeasance, nonfeasance, or malpractice in connection with the furnishing of such services and supplies.

"(e) Nothing in this chapter shall be construed in any way to repeal or conflict with any provision of the certificate of need law.

"(f) Notwithstanding the provisions of subsection (a), a health maintenance organization shall be subject to all of the following:

"(1) Section 27-1-17.

"(2) Chapter 56, regarding the Access to Eye Care Act.

"(3) Chapter 54, regarding mental illness coverage.

"(4) Chapter 57, requiring coverage to be offered for the payment of colorectal cancer examinations for covered persons who are 50 years of age or older, or for covered persons who are less than 50 years of age and at high risk for colorectal cancer according to current American Cancer Society colorectal cancer screening guidelines.

"(5) Chapter 58, requiring that policies and contracts including coverage for prostate cancer early detection be offered, together with identification of associated costs.

"(6) Chapter 59, requiring that policies and contracts including coverage for chiropractic be offered, together with identification of associated costs.

"(7) Rules promulgated by the Commissioner of Insurance pursuant to Sections 27-7-43 and 27-7-44.

"(8) Chapter 12A.

"(9) Chapter 54A, requiring policies and contracts to offer coverage for certain treatment for Autism Spectrum Disorder under certain conditions.

"(10) Chapter 2B, regarding risk-based capital.

"(11) Chapter 29, regarding insurance holding company systems.

"(12) Section 1 of the act adding this subdivision relating to abuse-deterrent opioid analgesic drug products."

Section 3. This act shall become effective on January 1, 2016.

Insurance

Health Benefit Plans

Health

Drugs

Abuse-Deterrent Opioid Analgesic

Code Amended