HB2961 HH&HR AM 2-26

            Delegate Householder moves to amend the bill on page 1, line 13, by striking everything after the enacting clause and inserting in lieu thereof the following:

            “That the Code of West Virginia, 1931, as amended, be amended by adding thereto a new section, designated §33-15-4m; that said code be amended by adding thereto a new section, designated §33-16-3y; that said code be amended by adding thereto a new section, designated §33-24-7m; that said code be amended by adding thereto a new section, designated §33-25-8k; that said code be amended by adding thereto a new section, designated §33-25A-8m; all to read as follows:

ARTICLE 15. ACCIDENT AND SICKNESS INSURANCE.

§33-15-4m. Deductibles, copayments and coinsurance for abuse deterrent opioid analgesic drugs.

            (a) These terms shall mean:

            (1) “Opioid analgesic drug product” means a drug product in the opioid analgesic drug calss prescribed to treat moderate to serve 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.

            (2) “Abuse-deterrent opioid analgesic drug product” means a brand or generic opioid analgesic drug product approved by the United States Food and Drug Administration with abuse-deterrence labeling claims that indicate the drug product is expected to result in a meaningful reduction in abuse.

            (3) “Cost sharing” means any coverage limit, copayment, coinsurance, deductible, or other out of pocket expense requirements.

            (b) Any accident and sickness insurance policy issued or renewed on or after July 1, 2016, shall provide coverage for abuse-deterrent opioid analgesic drugs as preferred drugs on their formulary, preferred drug list or other lists of similar construct. Cost-sharing for abuse-deterrent opioid analgesic drug product may not exceed the lowest cost sharing level applied to prescription drugs. An increase in patient cost sharing or other disincentives for prescribers or dispensers is not allowed to achieve compliance with this section.

ARTICLE 16. GROUP ACCIDENT AND SICKNESS INSURANCE.

§33-16-3y. Deductibles, copayments and coinsurance for abuse deterrent opioid analgesic drugs.

            (a) These terms shall mean:

            (1) “Opioid analgesic drug product” means a drug product in the opioid analgesic drug calss prescribed to treat moderate to serve 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.

            (2) “Abuse-deterrent opioid analgesic drug product” means a brand or generic opioid analgesic drug product approved by the United States Food and Drug Administration with abuse-deterrence labeling claims that indicate the drug product is expected to result in a meaningful reduction in abuse.

            (3) “Cost sharing” means any coverage limit, copayment, coinsurance, deductible, or other out of pocket expense requirements.

            (b) Any group accident and sickness insurance policy issued or renewed on or after July 1, 2016, shall provide coverage for abuse-deterrent opioid analgesic drugs as preferred drugs on their formulary, preferred drug list or other lists of similar construct. Cost-sharing for abuse-deterrent opioid analgesic drug product may not exceed the lowest cost sharing level applied to prescription drugs. An increase in patient cost sharing or other disincentives for prescribers or dispensers is not allowed to achieve compliance with this section.

ARTICLE 24. HOSPITAL SERVICE CORPORATIONS, MEDICAL SERVICE CORPORATIONS, DENTAL SERVICE CORPORATIONS AND HEALTH SERVICE CORPORATIONS.

§33-24-7n. Deductibles, copayments and coinsurance for abuse deterrent opioid analgesic drugs.

            (a) These terms shall mean:

            (1) “Opioid analgesic drug product” means a drug product in the opioid analgesic drug calss prescribed to treat moderate to serve 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.

            (2) “Abuse-deterrent opioid analgesic drug product” means a brand or generic opioid analgesic drug product approved by the United States Food and Drug Administration with abuse-deterrence labeling claims that indicate the drug product is expected to result in a meaningful reduction in abuse.

            (3) “Cost sharing” means any coverage limit, copayment, coinsurance, deductible, or other out of pocket expense requirements.

            (b) Notwithstanding any provision of any policy, provision, contract, plan or agreement to which this article applies, on or after July 1, 2016, it shall provide coverage for abuse-deterrent opioid analgesic drugs as preferred drugs on their formulary, preferred drug list or other lists of similar construct. Cost-sharing for abuse-deterrent opioid analgesic drug product may not exceed the lowest cost sharing level applied to prescription drugs. An increase in patient cost sharing or other disincentives for prescribers or dispensers is not allowed to achieve compliance with this section.

ARTICLE 25. HEALTH CARE CORPORATIONS.

§33-25-8k. Deductibles, copayments and coinsurance for abuse deterrent opioid analgesic drugs.

            (a) These terms shall mean:

            (1) “Opioid analgesic drug product” means a drug product in the opioid analgesic drug calss prescribed to treat moderate to serve 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.

            (2) “Abuse-deterrent opioid analgesic drug product” means a brand or generic opioid analgesic drug product approved by the United States Food and Drug Administration with abuse-deterrence labeling claims that indicate the drug product is expected to result in a meaningful reduction in abuse.

            (3) “Cost sharing” means any coverage limit, copayment, coinsurance, deductible, or other out of pocket expense requirements.

            (b) Notwithstanding any provision of any policy, contract, plan or agreement to which this article applies, a policy, contract, plan or agreement issued to a member or subscriber by an entity regulated by this article by July 1, 2016 that covers abuse-deterrent opioid analgesic drugs as preferred drugs on their formulary, preferred drug list or other lists of similar construct. Cost-sharing for abuse-deterrent opioid analgesic drug product may not exceed the lowest cost sharing level applied to prescription drugs. An increase in patient cost sharing or other disincentives for prescribers or dispensers is not allowed to achieve compliance with this section.

ARTICLE 25A. HEALTH MAINTENANCE ORGANIZATION ACT.

§33-25A-8m. Deductibles, copayments and coinsurance for abuse deterrent opioid analgesic drugs.

            (a) These terms shall mean:

            (1) “Opioid analgesic drug product” means a drug product in the opioid analgesic drug calss prescribed to treat moderate to serve 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.

            (2) “Abuse-deterrent opioid analgesic drug product” means a brand or generic opioid analgesic drug product approved by the United States Food and Drug Administration with abuse-deterrence labeling claims that indicate the drug product is expected to result in a meaningful reduction in abuse.

            (3) “Cost sharing” means any coverage limit, copayment, coinsurance, deductible, or other out of pocket expense requirements.

            (b) Notwithstanding any provision of any policy, contract, plan or agreement to which this article applies, any policy, contract, plan or agreement issued by a health maintenance organization pursuant to this article by July 1, 2016, that covers abuse-deterrent opioid analgesic drugs as preferred drugs on their formulary, preferred drug list or other lists of similar construct. Cost-sharing for abuse-deterrent opioid analgesic drug product may not exceed the lowest cost sharing level applied to prescription drugs. An increase in patient cost sharing or other disincentives for prescribers or dispensers is not allowed to achieve compliance with this section.