Medication Assisted Treatment

Referred to Committee on INSURANCE AND REAL ESTATE

Introduced by:

   (INS)

AN ACT ESTABLISHING MEDICATION-ASSISTED TREATMENT COVERAGE REQUIREMENTS.

Be it enacted by the Senate and House of Representatives in General

Assembly convened:

Section 1. (NEW) (Effective January 1, 2021) For the purposes of this section and section 2, of this act:

 (1) “Health carrier” or “carrier” means an insurer, fraternal benefit society, health care center, hospital service corporation, managed care organization, medical service corporation or other entity that delivers, issues for delivery, renews, amends or continues in this state any individual or group health insurance policy.

(2) “Mental health and substance use disorder benefits” means benefits for the treatment of any condition or disorder that involves a mental health condition or substance use disorder that falls under any of the diagnostic categories listed in the mental disorders section of the current edition of the International Classification of Disease or that is listed in the mental disorders section of the most recent version of the Diagnostic and Statistical Manual of Mental Disorders.

Sec. 2. (NEW) (Effective January 1, 2021) (a) Each health carrier that provides prescription drug benefits for the treatment of substance use disorders shall not impose any prior authorization requirements on any prescription medication approved by the federal Food and Drug Administration (FDA) for the treatment of substance use disorders.

(b) Each health carrier that provides prescription drug benefits for the treatment of substance use disorders shall not impose any step therapy requirements before the health carrier will authorize coverage for a prescription medication approved by the FDA for the treatment of substance use disorders.

(c) Each health carrier that provides prescription drug benefits for the treatment of substance use disorders shall place all prescription medications approved by the FDA for the treatment of substance use disorders on the lowest tier of the drug formulary developed and maintained by the health carrier.

(d) Each health carrier that provides prescription drug benefits for the treatment of substance use disorders shall not exclude coverage for any prescription medication approved by the FDA for the treatment of substance use disorders and any associated counseling or wraparound services on the grounds that such medications and services were court ordered.

Statement of Purpose:
To establish coverage requirements for medications to treat substance use disorders.