Bill > S06937

This bill requires insurance carriers and health plans to provide coverage for at least one abuse-deterrent opioid medication per active ingredient, with specific cost-sharing protections designed to make these medications more accessible. An abuse-deterrent opioid is a medication approved by the FDA with special properties that are intended to make the drug more difficult to misuse or abuse, such as by making it harder to crush or dissolve. The bill mandates that cost-sharing for these medications cannot exceed the lowest cost-sharing level for non-abuse-deterrent opioids in the same health plan, whether for brand name or generic versions. Additionally, insurers cannot impose new prior-authorization requirements or utilization review measures that would force patients to use non-abuse-deterrent opioids before accessing abuse-deterrent versions. The legislation defines opioid analgesic drug products broadly to include pain medications in various forms and release types, and specifically identifies abuse-deterrent medications as those with FDA-approved labeling indicating their ability to deter potential misuse. The law will take effect 120 days after becoming law and will apply to all insurance policies issued, renewed, or modified after that date.

Business and Industry

https://www.nysenate.gov/legislation/bills/2025/S6937