Session of 2025
HOUSE BILL No. 2364
By Committee on Health and Human Services
Requested by Dan Murray, on behalf of the American Chronic Pain Association
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AN ACT concerning health insurance; relating to coverage for nonopioid
prescription drugs for the treatment of pain; prohibiting certain health
insurers from requiring cost-sharing for nonopioid prescription drugs or
providing less favorable coverage for such drug than that for opioid or
narcotic prescription drugs.
Be it enacted by the Legislature of the State of Kansas:
Section 1. (a) As used in this section:
(1) "Health insurer" means the medicaid program as defined in
K.S.A. 75-7427, and amendments thereto, the state children's health
insurance program as provided in K.S.A. 38-2001 et seq., and amendments
thereto, and the state employee health benefits plan as established by
K.S.A. 75-37,162, and amendments thereto, including any managed care
organization for any such program or plan.
(2) "Prescriber" means the same as defined in K.S.A. 65-1626, and
amendments thereto.
(b) Notwithstanding any provision of law to the contrary, when a
prescriber prescribes a nonopioid medication for the treatment of acute
pain, a health insurer shall not:
(1) Deny coverage of the nonopioid prescription drug in favor of an
opioid prescription drug; or
(2) require the patient to try an opioid prescription drug prior to
providing coverage of the nonopioid prescription drug.
(c) In establishing and maintaining its drug formulary, a health
insurer shall ensure that no nonopioid drug approved by the United States
food and drug administration for the treatment or management of pain
shall be disadvantaged or discouraged, with respect to coverage or cost
sharing, relative to any opioid or narcotic drug for the treatment or
management of pain on the health insurance issuer's drug formulary.
Impermissible disadvantaging or discouragement includes, but is not
limited to:
(1) Imposing more restrictive coverage criteria on any such nonopioid
drug than the least restrictive coverage criteria imposed on an opioid or
narcotic drug;
(2) establishing more restrictive or more extensive utilization
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controls, including, but not limited to, more restrictive or more extensive
prior authorization or step therapy requirements for such nonopioid drug
than the least restrictive or extensive utilization controls applicable to any
such opioid or narcotic drug; or
(3) if the health insurance issuer maintains a drug formulary grouped
into tiers for the purposes of determining cost-sharing, placing any such
nonopioid drug on a tier that requires a cost-sharing responsibility
exceeding the lowest cost-sharing responsibility required for any opioid or
narcotic drug on the drug formulary.
(d) This subsection shall not preclude opioid drugs from being
preferred over other opioid drugs or nonopioid drugs from being preferred
over other nonopioid drugs.
Sec. 2. This act shall take effect and be in force from and after its
publication in the statute book.
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