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 TLSB 2149XC (1) 91 nls/ko
S.F. _____ 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: 35 -1- LSB 2149XC (1) 91 nls/ko 1/ 5
S.F. _____ 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. 35 -2- LSB 2149XC (1) 91 nls/ko 2/ 5
S.F. _____ 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 carriers 17 pain management access plan to health care providers in the 18 health carriers network, and to the health carriers covered 19 persons. The health carrier shall make the pain management 20 access plan publicly available on the health carriers 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 explanations 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 35 -3- LSB 2149XC (1) 91 nls/ko 3/ 5
S.F. _____ 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 carriers 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 35 -4- LSB 2149XC (1) 91 nls/ko 4/ 5
S.F. _____ preferential coverage of, and access to, opioid drugs. 1 A health carrier shall annually distribute educational 2 materials to providers within the health carriers network, 3 and to covered persons, about the health carriers plan, and 4 shall make the plan publicly available on the health carriers 5 internet site. 6 The commissioner of insurance may adopt rules to administer 7 the bill. 8 -5- LSB 2149XC (1) 91 nls/ko 5/ 5