Bill Text: IA SSB1169 | 2025-2026 | 91st General Assembly | Introduced
Bill Title: A bill for an act relating to nonopioid drugs on the medical assistance preferred drug list, and health carriers' development of a pain management access plan.
Spectrum: Committee Bill
Status: (Introduced) 2025-02-20 - Subcommittee: Klimesh, Campbell, and Zimmer. [SSB1169 Detail]
Download: Iowa-2025-SSB1169-Introduced.html
Senate
Study
Bill
1169
-
Introduced
SENATE
FILE
_____
BY
(PROPOSED
COMMITTEE
ON
HEALTH
AND
HUMAN
SERVICES
BILL
BY
CHAIRPERSON
KLIMESH)
A
BILL
FOR
An
Act
relating
to
nonopioid
drugs
on
the
medical
assistance
1
preferred
drug
list,
and
health
carriers’
development
of
a
2
pain
management
access
plan.
3
BE
IT
ENACTED
BY
THE
GENERAL
ASSEMBLY
OF
THE
STATE
OF
IOWA:
4
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Section
1.
Section
249A.20A,
Code
2025,
is
amended
by
adding
1
the
following
new
subsection:
2
NEW
SUBSECTION
.
12.
a.
In
establishing
and
maintaining
a
3
preferred
drug
list,
a
nonopioid
drug
approved
by
the
United
4
States
food
and
drug
administration
for
the
treatment
or
5
management
of
pain
shall
not
be
disadvantaged
or
discouraged
6
with
respect
to
Medicaid
coverage
relative
to
an
opioid
or
7
narcotic
drug
for
the
treatment
or
management
of
pain
on
the
8
preferred
drug
list.
9
b.
Impermissible
disadvantaging
or
discouragement
under
this
10
subsection
includes
all
of
the
following:
11
(1)
Designating
a
nonopioid
drug
for
the
treatment
or
12
management
of
pain
as
a
nonpreferred
drug
if
any
opioid
or
13
narcotic
drug
for
the
treatment
or
management
of
pain
is
14
designated
as
a
preferred
drug.
15
(2)
Establishing
more
restrictive
or
more
extensive
16
utilization
controls,
including
but
not
limited
to
more
17
restrictive
or
more
extensive
prior
authorization
or
step
18
therapy
requirements
for
a
nonopioid
drug
for
the
treatment
19
or
management
of
pain
than
the
least
restrictive
or
extensive
20
utilization
controls
applicable
to
an
opioid
or
narcotic
drug
21
for
the
treatment
or
management
of
pain.
22
c.
This
subsection
shall
apply
to
a
nonopioid
drug
23
immediately
upon
approval
of
the
drug
by
the
United
States
food
24
and
drug
administration
for
the
treatment
or
management
of
25
pain,
regardless
of
whether
the
drug
has
been
reviewed
by
the
26
medical
assistance
pharmaceutical
and
therapeutics
committee
27
for
inclusion
on
the
preferred
drug
list.
28
d.
This
subsection
shall
apply
to
drugs
being
provided
under
29
a
contract
between
the
department
and
a
Medicaid
managed
care
30
organization.
31
Sec.
2.
NEW
SECTION
.
505.36
Health
carriers
——
pain
32
management
access
plans.
33
1.
Definitions.
As
used
in
this
section,
unless
the
context
34
otherwise
requires:
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a.
“Covered
person”
means
a
policyholder,
subscriber,
1
enrollee,
or
other
individual
participating
in
a
health
benefit
2
plan.
3
b.
“Health
benefit
plan”
means
a
policy,
contract,
4
certificate,
or
agreement
offered
or
issued
by
a
health
carrier
5
to
provide,
deliver,
arrange
for,
pay
for,
or
reimburse
any
of
6
the
costs
of
health
care
services.
7
c.
“Health
carrier”
means
an
entity
subject
to
the
8
insurance
laws
and
regulations
of
this
state,
or
subject
9
to
the
jurisdiction
of
the
commissioner,
including
an
10
insurance
company
offering
sickness
and
accident
plans,
a
11
health
maintenance
organization,
a
nonprofit
health
service
12
corporation,
a
plan
established
pursuant
to
chapter
509A
13
for
public
employees,
or
any
other
entity
providing
a
plan
14
of
health
insurance,
health
care
benefits,
or
health
care
15
services.
16
d.
“Pain
management
access
plan”
means
a
plan
developed
by
17
a
health
carrier
to
provide
adequate
coverage
and
access
to
a
18
broad
spectrum
of
pain
management
alternatives
under
a
health
19
benefit
plan.
20
e.
“Pain
management
alternatives”
means
alternatives
to
21
opioid
drugs
including
but
not
limited
to
nonopioid
medicinal
22
drugs
or
drug
products
for
the
treatment
or
management
of
pain,
23
and
nonpharmacologic,
nonoperative
pain
management
modalities.
24
2.
Pain
management
access
plan.
A
health
carrier
shall
25
develop
and
implement
a
pain
management
access
plan
that
26
satisfies
all
of
the
following
requirements:
27
a.
The
plan
provides
coverage
for
pain
management
28
alternatives
including
coverage
for
all
of
the
following:
29
(1)
A
minimum
of
two
alternative
prescription
medication
30
treatment
options
that
are
approved
by
the
United
States
food
31
and
drug
administration
for
the
treatment
of
pain,
and
that
are
32
not
schedule
I,
II,
or
III
controlled
substances.
33
(2)
A
minimum
of
three
alternative
nonpharmacologic
34
treatment
modalities.
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b.
The
plan
does
not
establish
utilization
controls,
1
including
but
not
limited
to
prior
authorization
or
step
2
therapy
requirements,
for
clinically
appropriate
nonopioid
3
drugs
or
drug
products
approved
by
the
United
States
food
4
and
drug
administration
for
the
treatment
or
management
of
5
pain,
that
are
more
restrictive
or
extensive
than
the
least
6
restrictive
or
extensive
utilization
controls
applicable
to
7
an
opioid
or
narcotic
drug
for
the
treatment
or
management
of
8
pain.
9
3.
Filing
and
review.
A
health
carrier
shall
file
the
pain
10
management
access
plan
with
the
division
for
approval.
In
11
reviewing
a
plan,
the
division
shall
determine
if
the
health
12
carrier
is
in
compliance
with
the
requirements
of
this
section
13
and
if
any
policies
adopted
by
the
health
carrier
may
create
14
preferential
coverage
of,
and
access
to,
opioid
drugs.
15
4.
Plan
information.
A
health
carrier
shall
annually
16
distribute
educational
materials
about
the
health
carrier’s
17
pain
management
access
plan
to
health
care
providers
in
the
18
health
carrier’s
network,
and
to
the
health
carrier’s
covered
19
persons.
The
health
carrier
shall
make
the
pain
management
20
access
plan
publicly
available
on
the
health
carrier’s
internet
21
site.
22
5.
Rules.
The
commissioner
of
insurance
may
adopt
rules
23
pursuant
to
chapter
17A
to
administer
this
section.
24
EXPLANATION
25
The
inclusion
of
this
explanation
does
not
constitute
agreement
with
26
the
explanation’s
substance
by
the
members
of
the
general
assembly.
27
This
bill
relates
to
nonopioid
drugs
on
the
medical
28
assistance
preferred
drug
list,
and
health
carriers’
29
development
of
a
pain
management
access
plan.
30
Under
the
bill,
in
establishing
and
maintaining
a
preferred
31
drug
list
under
Code
section
249A.20A,
a
nonopioid
drug
32
approved
by
the
United
States
food
and
drug
administration
33
(FDA)
for
the
treatment
or
management
of
pain
shall
not
be
34
disadvantaged
or
discouraged
with
respect
to
Medicaid
coverage
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for
an
opioid
or
narcotic
drug
for
the
treatment
or
management
1
of
pain
on
the
preferred
drug
list.
2
Impermissible
disadvantaging
or
discouragement
of
a
3
nonopioid
drug
includes
designating
the
nonopioid
drug
as
a
4
nonpreferred
drug
if
any
opioid
or
narcotic
is
designated
as
a
5
preferred
drug,
and
establishing
more
restrictive
or
extensive
6
utilization
controls
for
a
nonopioid
drug
than
the
least
7
restrictive
or
extensive
utilization
controls
applicable
to
an
8
opioid
or
narcotic
drug.
9
The
bill
applies
to
a
nonopioid
drug
immediately
upon
its
10
approval
by
the
FDA
for
the
treatment
or
management
of
pain,
11
regardless
of
whether
the
drug
has
been
reviewed
by
the
medical
12
assistance
pharmaceutical
and
therapeutics
committee
for
13
inclusion
on
the
preferred
drug
list.
The
bill
also
applies
to
14
drugs
being
provided
under
a
contract
between
the
department
15
and
a
Medicaid
managed
care
organization.
16
Under
the
bill,
a
health
carrier
shall
develop
and
implement
17
a
pain
management
access
plan
(plan).
“Pain
management
access
18
plan”
and
“pain
management
alternatives”
are
defined
in
the
19
bill.
20
A
plan
shall
provide
coverage
for
a
minimum
of
two
21
alternative
prescription
medication
treatment
options
that
are
22
approved
by
the
FDA
for
the
treatment
of
pain,
and
that
are
23
not
schedule
I,
II,
or
III
controlled
substances;
and
provide
24
coverage
for
a
minimum
of
three
alternative
nonpharmacologic
25
treatment
modalities.
A
health
carrier’s
plan
shall
not
26
establish
utilization
controls
for
clinically
appropriate
27
nonopioid
drugs
or
drug
products
approved
by
the
FDA
that
28
are
more
restrictive
or
extensive
than
the
least
restrictive
29
or
extensive
utilization
controls
applicable
to
an
opioid
or
30
narcotic
drug.
31
A
health
carrier
shall
file
the
plan
with
the
insurance
32
division
for
approval.
In
reviewing
a
plan,
the
division
shall
33
determine
if
the
health
carrier
is
in
compliance
with
the
bill,
34
and
if
any
policies
adopted
by
the
health
carrier
may
create
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preferential
coverage
of,
and
access
to,
opioid
drugs.
1
A
health
carrier
shall
annually
distribute
educational
2
materials
to
providers
within
the
health
carrier’s
network,
3
and
to
covered
persons,
about
the
health
carrier’s
plan,
and
4
shall
make
the
plan
publicly
available
on
the
health
carrier’s
5
internet
site.
6
The
commissioner
of
insurance
may
adopt
rules
to
administer
7
the
bill.
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