SB 26-6

Senate Bill 26-6, which has been signed into law, aims to ensure that health insurance plans cover non-opioid pain management drugs on par with opioid medications. This means that insurance companies must not impose stricter requirements for prior authorization or higher costs for non-opioid treatments compared to opioids when managing chronic or acute pain. The bill affects individuals who rely on health insurance for pain medication and ensures they have access to affordable, non-opioid options as alternatives to opioids. Since the bill has been signed, it is now law and will impact how insurance companies handle coverage for these medications.

Official Summary

The act requires a health insurance carrier that provides prescription drug benefits to require that:The utilization review requirements, including prior authorization and step therapy, for a non-opioid drug prescribed and approved by the federal food and drug administration (FDA) for the treatment or management of chronic or acute pain (non-opioid pain management drug) are no more restrictive than the least restrictive utilization review requirements for opioid drugs prescribed for the treatment or management of chronic or acute pain; andThe cost-sharing, copayment, or deductible for a non-opioid pain management drug is not greater than the cost-sharing, copayment, or deductible for an opioid drug prescribed for the treatment or management of chronic or acute pain.     The act requires each individual and small group health benefit plan issued or renewed on or after January 1, 2027, and each large employer health benefit plan issued or renewed on and after January 1, 2028, to ensure there is at least one non-opioid pain management drug available as a clinically appropriate alternative for an opioid pain management drug. If the division of insurance determines that coverage for a non-opioid pain management drug offered by individual and small group health benefit plans requires state defrayal of the cost of coverage, the requirement to make a non-opioid pain management drug available is inoperative.     The state employee health benefit plan is excluded from the requirements of the act.     The act appropriates $15,415 to the department of regulatory agencies for use by the division of insurance to implement the act.(Note: This summary applies to this bill as enacted.)

Topics

Votes