Senate File 410 H-1169 Amend Senate File 410, as amended, passed, and 1 reprinted by the Senate, as follows: 2 1. Page 7, after line 2 by inserting: 3 < Sec. ___. NEW SECTION . 514C.30 Opioid analgesic 4 drug products —— coverage. 5 1. Definitions. For purposes of this section, 6 unless the context otherwise requires: 7 a. “Abuse-deterrent opioid analgesic drug product” 8 means a brand-name or generic opioid analgesic drug 9 product approved by the United States food and drug 10 administration with abuse-deterrence labeling claims 11 that indicate the product is expected to result in a 12 meaningful reduction in abuse of opioids. 13 b. “Carrier” means an entity that provides health 14 benefit plans in this state. 15 c. “Health benefit plan” means a policy, 16 certificate, or contract providing hospital or medical 17 coverage, benefits, or services rendered by a health 18 care provider. 19 d. “Opioid analgesic drug product” means a drug 20 product in the opioid analgesic drug class prescribed 21 to treat moderate to severe pain or other conditions 22 and includes immediate release, extended release, and 23 long-acting forms, whether or not combined with other 24 drug substances to form a single drug product or dosage 25 form. 26 2. Coverage required. 27 a. Notwithstanding the uniformity of treatment 28 requirements of section 514C.6, a contract, policy, or 29 plan providing for third-party payment or prepayment 30 of health or medical expenses that provides coverage 31 benefits for opioid analgesic drug products shall 32 provide coverage for all abuse-deterrent opioid 33 analgesic drug products as a preferred drug on the 34 carrier’s drug formulary or preferred drug list. 35 b. Cost-sharing requirements for abuse-deterrent 36 opioid analgesic drug products shall not exceed the 37 lowest cost-sharing requirements applied to other 38 covered prescription drugs on the carrier’s drug 39 formulary or preferred drug list. 40 3. Prior authorization. 41 a. A prior authorization or utilization review 42 requirement shall not require prior use of an opioid 43 analgesic drug product other than an abuse-deterrent 44 opioid analgesic drug product as a prerequisite for 45 access to an abuse-deterrent opioid analgesic drug 46 product. 47 b. This subsection shall not be construed to 48 prevent a carrier from requiring prior authorization 49 for an abuse-deterrent opioid analgesic drug product, 50 -1- SF410.1220 (3) 86 jh/nh 1/ 2 #1.

provided that the same prior authorization requirements 1 are applied to all versions of the same opioid 2 analgesic drug products that are not abuse-deterrent 3 opioid analgesic drug products. 4 4. Applicability. 5 a. This section applies to the following classes 6 of third-party payment provider contracts or policies 7 delivered, issued for delivery, continued, or renewed 8 in this state on or after July 1, 2015: 9 (1) Individual or group accident and sickness 10 insurance providing coverage on an expense-incurred 11 basis. 12 (2) An individual or group hospital or medical 13 service contract issued pursuant to chapter 509, 514, 14 or 514A. 15 (3) An individual or group health maintenance 16 organization contract regulated under chapter 514B. 17 (4) Any other entity engaged in the business of 18 insurance, risk transfer, or risk retention, which is 19 subject to the jurisdiction of the commissioner. 20 (5) A plan established pursuant to chapter 509A for 21 public employees. 22 (6) An organized delivery system licensed by the 23 director of public health. 24 b. This section shall not apply to accident-only, 25 specified disease, short-term hospital or medical, 26 hospital confinement indemnity, credit, dental, vision, 27 Medicare supplement, long-term care, basic hospital 28 and medical-surgical expense coverage as defined 29 by the commissioner, disability income insurance 30 coverage, coverage issued as a supplement to liability 31 insurance, workers’ compensation or similar insurance, 32 or automobile medical payment insurance. > 33 2. Title page, by striking lines 2 and 3 and 34 inserting < limiting criminal and civil liability, 35 modifying penalties, and providing an applicability 36 date. > 37 3. By renumbering as necessary. 38 ______________________________ COMMITTEE ON PUBLIC SAFETY BAUDLER of Adair, Chairperson -2- SF410.1220 (3) 86 jh/nh 2/ 2 #2. #3.