Bill Text: NY S05013 | 2025-2026 | General Assembly | Introduced

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Bill Title: Requires health insurers to provide coverage for opioid antagonists and devices.

Spectrum: Partisan Bill (Democrat 1-0)

Status: (Introduced) 2025-02-18 - REFERRED TO INSURANCE [S05013 Detail]

Download: New_York-2025-S05013-Introduced.html

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                STATE OF NEW YORK
        ________________________________________________________________________

                                          5013

                               2025-2026 Regular Sessions

                    IN SENATE

                                    February 18, 2025
                                       ___________

        Introduced  by Sen. HARCKHAM -- read twice and ordered printed, and when
          printed to be committed to the Committee on Insurance

        AN ACT to amend the insurance  law,  in  relation  to  requiring  health
          insurers to provide coverage for opioid antagonists and devices

          The  People of the State of New York, represented in Senate and Assem-
        bly, do enact as follows:

     1    Section 1. Subsection (i) of section 3216  of  the  insurance  law  is
     2  amended by adding a new paragraph 41 to read as follows:
     3    (41)  (A)  (i)  Every  policy which provides coverage for prescription
     4  drugs shall include coverage for at  least  one  opioid  antagonist  and
     5  device.  Prior  authorization  may  be required for non-generic forms of
     6  opioid antagonists and devices.
     7    (ii) As used in this paragraph "opioid antagonist and device" means  a
     8  drug  approved  by  the food and drug administration that, when adminis-
     9  tered, negates or neutralizes in whole or in  part  the  pharmacological
    10  effects  of  an opioid in the body. "Opioid antagonist" shall be limited
    11  to naloxone and other medications approved by the department  of  health
    12  for such purpose.
    13    (B)  The  coverage  mandated  by  this  paragraph shall include opioid
    14  antagonists prescribed or dispensed via standing order or  collaborative
    15  practice agreement intended for use on patients other than the insured.
    16    (C)  Coverage  provided  under this paragraph may be subject to annual
    17  deductibles and co-insurance as deemed appropriate by the superintendent
    18  and that are consistent with those imposed on other  benefits  within  a
    19  given policy.
    20    § 2. Subsection (l) of section 3221 of the insurance law is amended by
    21  adding a new paragraph 7-c to read as follows:
    22    (7-c)  (A)  (i)  Every policy which provides coverage for prescription
    23  drugs shall include coverage for at  least  one  opioid  antagonist  and
    24  device.  Prior  authorization  may  be required for non-generic forms of
    25  opioid antagonists and devices.

         EXPLANATION--Matter in italics (underscored) is new; matter in brackets
                              [ ] is old law to be omitted.
                                                                   LBD09743-02-5
        S. 5013                             2

     1    (ii) As used in this paragraph "opioid antagonist and device" means  a
     2  drug  approved  by  the food and drug administration that, when adminis-
     3  tered, negates or neutralizes in whole or in  part  the  pharmacological
     4  effects  of  an opioid in the body. "Opioid antagonist" shall be limited
     5  to  naloxone  and other medications approved by the department of health
     6  for such purpose.
     7    (B) The coverage mandated  by  this  paragraph  shall  include  opioid
     8  antagonists  prescribed or dispensed via standing order or collaborative
     9  practice agreement intended for use on patients other than the insured.
    10    (C) Coverage provided under this paragraph may be  subject  to  annual
    11  deductibles and co-insurance as deemed appropriate by the superintendent
    12  and  that  are  consistent with those imposed on other benefits within a
    13  given policy.
    14    § 3. Section 4303 of the insurance law is  amended  by  adding  a  new
    15  subsection (ww) to read as follows:
    16    (ww)  (1)  (A)  Every  policy which provides coverage for prescription
    17  drugs shall include coverage for at  least  one  opioid  antagonist  and
    18  device.  Prior  authorization  may  be required for non-generic forms of
    19  opioid antagonists and devices.
    20    (B) As used in this subsection "opioid antagonist and device" means  a
    21  drug  approved  by  the food and drug administration that, when adminis-
    22  tered, negates or neutralizes in whole or in  part  the  pharmacological
    23  effects  of  an opioid in the body. "Opioid antagonist" shall be limited
    24  to naloxone and other medications approved by the department  of  health
    25  for such purpose.
    26    (2)  Coverage  provided under this subsection may be subject to annual
    27  deductibles and co-insurance as deemed appropriate by the superintendent
    28  and that are consistent with those imposed on other  benefits  within  a
    29  given policy.
    30    §  4.  This  act shall take effect on the thirtieth day after it shall
    31  have become a law.