Bill > SSB1169

Introduced Session

This bill relates to nonopioid drugs on the medical assistance preferred drug list, and health carriers’ development of a pain management access plan. Under the bill, in establishing and maintaining a preferred drug list under Code section 249A.20A, a nonopioid drug approved by the United States food and drug administration (FDA) for the treatment or management of pain shall not be disadvantaged or discouraged with respect to Medicaid coverage S.F. _____ for an opioid or narcotic drug for the treatment or management of pain on the preferred drug list. Impermissible disadvantaging or discouragement of a nonopioid drug includes designating the nonopioid drug as a nonpreferred drug if any opioid or narcotic is designated as a preferred drug, and establishing more restrictive or extensive utilization controls for a nonopioid drug than the least restrictive or extensive utilization controls applicable to an opioid or narcotic drug. The bill applies to a nonopioid drug immediately upon its approval by the FDA for the treatment or management of pain, regardless of whether the drug has been reviewed by the medical assistance pharmaceutical and therapeutics committee for inclusion on the preferred drug list. The bill also applies to drugs being provided under a contract between the department and a Medicaid managed care organization. Under the bill, a health carrier shall develop and implement a pain management access plan (plan). “Pain management access plan” and “pain management alternatives” are defined in the bill. A plan shall provide coverage for a minimum of two alternative prescription medication treatment options that are approved by the FDA for the treatment of pain, and that are not schedule I, II, or III controlled substances; and provide coverage for a minimum of three alternative nonpharmacologic treatment modalities. A health carrier’s plan shall not establish utilization controls for clinically appropriate nonopioid drugs or drug products approved by the FDA that are more restrictive or extensive than the least restrictive or extensive utilization controls applicable to an opioid or narcotic drug. A health carrier shall file the plan with the insurance division for approval. In reviewing a plan, the division shall determine if the health carrier is in compliance with the bill, and if any policies adopted by the health carrier may create S.F. _____ preferential coverage of, and access to, opioid drugs. A health carrier shall annually distribute educational materials to providers within the health carrier’s network, and to covered persons, about the health carrier’s plan, and shall make the plan publicly available on the health carrier’s internet site. The commissioner of insurance may adopt rules to administer the bill.

Committee Categories

No sponsors listed

Other Sponsors (1)

Subcommittee recommends amendment and passage. (on 03/04/2025)

Official Document