SB 428

This bill authorizes an insurer that offers group insurance plans ("insurer"") to adopt or amend a state preferred drug list (""PDL ""). In establishing and maintaining the PDL, this bill requires the insurer to ensure that a non-opioid drug approved by the food and drug administration (""FDA"") for the treatment or management of pain is not disadvantaged or discouraged with respect to c overage relative to an opioid or narcotic drug for the treatment or management of pain on the PDL. However, this bill does not prohibit an opioid medication from being preferred over other opioid medications, or a non-opioid medication from being prefer red over other non-opioid medications. This bill applies to a non-opioid drug immediately upon its approval by the FDA for the treatment or management of pain, regardless of whether the drug has been reviewed by the insurer for inclusion on the PDL. Th i s bill also applies to drugs being provided under a contract between the insurer and a pharmacy benefits manager for purposes of a group insurance plan. This bill requires an insurer to ensure that (i) reimbursement is provided to a healthcare prescribe r who provides a non-opioid treatment to a covered employee under the group insurance plan, and (ii) to the extent permitted by law, a hospital that provides either inpatient or outpatient services to a recipient is reimbursed separately under the group i n surance plan for any non-opioid treatment provided as a part of those services. ON MARCH 24, 2025, THE HOUSE ADOPTED AMENDMENT #1 AND PASSED HOUSE BILL 37, AS AMENDED. ' AMENDMENT #1 makes the following revisions:  Revises the provision that applies the bill to a non-opioid drug immediately upon its approval by the FDA for the treatment or management of pain to, instead apply the bill to a non-opioid drug after it has been approved by the FDA for a period of nine months or longer for such treatment or management.  Removes the provision requiring a n insurer, for purposes of offering a group insurance plan, to ensure that reimbursement is provided to a healthcare prescriber who provides a non-opioid treatment to a covered employee under the group insurance plan.  Removes the provision requiring an insurer to ensure that, to the extent permitted by law, a hospital that provides either inpatient or outpatient services to a recipient is reimbursed separately under the group insurance plan for any non-opioid treatment provided as a part of those services.  Changes the effective date from July 1, 2025, to January 1, 2026."