SB 2855: Health Insurance; Health Insurers; Mutual Benefit Societies; Health Maintenance Organizations; Prescription Drug Coverage; Opioid Antagonists

A BILL FOR AN ACT

relating to opioid antagonists.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF HAWAII:

     SECTION 1.  Chapter 431, Hawaii Revised Statutes, is amended by adding a new section to article 10A, part I, to be appropriately designated and to read as follows:

     "§431:10A-     Opioid antagonists; coverage.  (a)  Each individual or group policy of accident and health or sickness insurance that provides prescription drug coverage issued or renewed in the State on or after January 1, 2027, shall provide coverage for the policyholder, or any dependent of the policyholder who is covered by the policy, for at least one generic opioid antagonist and device.

     (b)  Generic opioid antagonists and devices covered by this section:

     (1)  Shall be placed on the lowest cost-sharing tier of the formulary managed by the health insurer or pharmacy benefits manager;

     (2)  Shall not be subject to any annual or lifetime dollar limitations;

     (3)  Shall not be subject to financial requirements and quantitative treatment limitations that do not comply with the Mental Health Parity and Addiction Equity Act of 2008, P.L. 110-343; and

     (4)  Shall not require prior authorization, except that prior authorization may be required for the prescription of non-generic forms of opioid antagonists and devices.

     (c)  For the purposes of this section:

     "Device" means an administration mechanism that delivers an opioid antagonist medication, including but not limited to prepackaged nasal spray, oral tablets, and auto-injectors.

     "Formulary" has the same meaning as in section 431:10A-140.

     "Opioid antagonist" means naloxone hydrochloride and any other drug approved by the United States Food and Drug Administration for the treatment of opioid overdose.

     "Pharmacy benefit manager" has the same meaning as in section 431R-1."

     SECTION 2.  Chapter 432, Hawaii Revised Statutes, is amended by adding a new section to article 1 to be appropriately designated and to read as follows:

     "§432:1-     Opioid antagonists; coverage.  (a)  Each individual or group hospital or medical service plan contract that provides prescription drug coverage issued or renewed in the State on or after January 1, 2027, shall provide coverage for the subscriber or member, or any dependent of the subscriber or member who is covered by the plan contract, for at least one generic opioid antagonist and device.

     (b)  Generic opioid antagonists and devices covered by this section:

     (1)  Shall be placed on the lowest cost-sharing tier of the formulary managed by the mutual benefit society or pharmacy benefits manager;

     (2)  Shall not be subject to any annual or lifetime dollar limitations;

     (3)  Shall not be subject to financial requirements and quantitative treatment limitations that do not comply with the Mental Health Parity and Addiction Equity Act of 2008, P.L. 110-343; and

     (4)  Shall not require prior authorization, except that prior authorization may be required for the prescription of non-generic forms of opioid antagonists and devices.

     (c)  For the purposes of this section:

     "Device" means an administration mechanism that delivers an opioid antagonist medication, including but not limited to prepackaged nasal spray, oral tablets, and auto-injectors.

     "Formulary" has the same meaning as in section 432:1-620.

     "Opioid antagonist" means naloxone hydrochloride and any other drug approved by the United States Food and Drug Administration for the treatment of opioid overdose.

     "Pharmacy benefit manager" has the same meaning as in section 431R-1."

     SECTION 3.  Chapter 432D, Hawaii Revised Statutes, is amended by adding a new section to be appropriately designated and to read as follows:

     "§432D-     Opioid antagonists; coverage.  (a)  Each health maintenance organization policy, contract, plan, or agreement issued or renewed in the State on or after January 1, 2027, shall provide coverage for the subscriber or enrollee, or any dependent of the subscriber or enrollee who is covered by the policy, contract, plan, or agreement, for at least one generic opioid antagonist and device.

     (b)  Generic opioid antagonists and devices covered by this section:

     (1)  Shall be placed on the lowest cost-sharing tier of the formulary managed by the health maintenance organization or pharmacy benefits manager;

     (2)  Shall not be subject to any annual or lifetime dollar limitations;

     (3)  Shall not be subject to financial requirements and quantitative treatment limitations that do not comply with the Mental Health Parity and Addiction Equity Act of 2008, P.L. 110-343; and

     (4)  Shall not require prior authorization, except that prior authorization may be required for the prescription of non-generic forms of opioid antagonists and devices.

     (c)  For the purposes of this section:

     "Device" means an administration mechanism that delivers an opioid antagonist medication, including but not limited to prepackaged nasal spray, oral tablets, and auto-injectors.

     "Formulary" has the same meaning as in section 431:10A-140.

     "Opioid antagonist" means naloxone hydrochloride and any other drug approved by the United States Food and Drug Administration for the treatment of opioid overdose.

     "Pharmacy benefit manager" has the same meaning as in section 431R-1."

     SECTION 5.  New statutory material is underscored.

     SECTION 6.  This Act shall take effect upon its approval.

Report Title:

Health Insurance; Health Insurers; Mutual Benefit Societies; Health Maintenance Organizations; Prescription Drug Coverage; Opioid Antagonists

Description:

Beginning 1/1/2027, requires health insurers, mutual benefit societies, and health maintenance organizations that issue policies, contracts, plans, or agreements that provide prescription drug coverage to provide coverage for at least one generic opioid antagonist and device.

The summary description of legislation appearing on this page is for informational purposes only and is not legislation or evidence of legislative intent.