The act requires a health benefit plan issued or renewed on or after January 1, 2023, to provide a cost-sharing benefit for nonpharmacological treatment where an opioid might be prescribed. The required cost-sharing benefit must include a cost-sharing amount not to exceed the cost-sharing amount for a primary care visit for nonpreventive services, at least 6 physical therapy visits, 6 occupational therapy visits, 6 chiropractic visits, and 6 acupuncture visits per year. The division of insurance (division) is required to submit to the federal department of human services a determination as to whether the cost-sharing benefit is in addition to an essential benefit and subject to defrayal by the state pursuant to federal law and a request for confirmation of the determination. The division is required to implement the benefit only if the benefit does not constitute an additional benefit that requires a defrayal.
The act requires an insurance carrier (carrier) that provides prescription drug benefits to provide coverage, beginning January 1, 2023, for at least one atypical opioid that is approved by the federal food and drug administration (FDA) for the treatment of acute or chronic pain, which coverage must be at the lowest cost-sharing tier of the carrier's formulary with no requirement for step therapy or prior authorization. Additionally, a carrier cannot require step therapy for any additional FDA-approved atypical opioids.
The act precludes a carrier that has a contract with a physical therapist, occupational therapist, chiropractor, or acupuncturist from:
- Prohibiting the physical therapist, occupational therapist, chiropractor, or acupuncturist from, or penalizing the physical therapist, occupational therapist, chiropractor, or acupuncturist for, providing a covered person information on the amount of the covered person's financial responsibility for the covered person's physical therapy, occupational therapy, chiropractic services, or acupuncture services; or
- Requiring the physical therapist, occupational therapist, chiropractor, or acupuncturist to charge a covered person an amount or collect a copayment from a covered person that exceeds the total charges submitted to the carrier by the physical therapist, occupational therapist, chiropractor, or acupuncturist.
The commissioner of insurance is required to take action against a carrier that the commissioner determines is not complying with these prohibitions.
Current law limits specified prescribers from prescribing more than a 7-day supply of an opioid to a patient who has not obtained an opioid prescription from that prescriber within the previous 12 months unless certain conditions apply. This prescribing limitation is set to repeal on September 1, 2021.The act continues the prescribing limitation indefinitely.
The also requires the applicable board for each prescriber to promulgate rules that limit the supply of a benzodiazepine, which is a sedative commonly prescribed for anxiety and as a sleep aid, that a prescriber may prescribe to a patient who has not had a prescription for a benzodiazepine in the last 12 months, except for benzodiazepines prescribed to treat specific disorders or conditions.
The act continues indefinitely the requirement that a health-care provider query the prescription drug monitoring program (program) before prescribing an opioid, including a benzodiazepine, and changes current law to require the query on every prescription fill, not just the second fill. This section also requires a practitioner to query the program before prescribing a benzodiazepine unless it is to treat a specific disorder or condition.
In addition to current law allowing medical examiners and coroners to query the program when conducting an autopsy, section 16 allows medical examiners and coroners to query the program when conducting a death investigation.
The act also authorizes the state board of pharmacy to provide a means of sharing prescription information from the program with the health information organization network in order to work collaboratively with statewide health information exchanges designated by the department of health care policy and financing.
The act requires the center for research into substance use disorder prevention, treatment, and recovery support strategies to include in its continuing education activities the best practices for prescribing benzodiazepines and the potential harm of inappropriately limiting prescriptions to chronic pain patients and makes an appropriation for this purpose.
The act directs the office of behavioral health in the department of human services to convene a collaborative with institutions of higher education, nonprofit agencies, and state agencies for the purpose of gathering feedback from local public health agencies, institutions of higher education, nonprofit agencies, and state agencies concerning evidence-based prevention practices.
$382,908 is appropriated to the department of human services for use by the office of behavioral health. $13,000 is appropriated to the department of regulatory agencies for use by the division of insurance. $215,207 is appropriated to the department of regulatory agencies.
(Note: This summary applies to this bill as enacted.)