House File 2380 H-8051 Amend House File 2380 as follows: 1 1. Page 2, after line 20 by inserting: 2 < Sec. ___. NEW SECTION . 514C.31 Opioid analgesic 3 drug products —— coverage. 4 1. Definitions. For purposes of this section, 5 unless the context otherwise requires: 6 a. “Abuse-deterrent opioid analgesic drug product” 7 means a brand-name or generic opioid analgesic drug 8 product approved by the United States food and drug 9 administration with abuse-deterrence labeling claims 10 that indicate the product is expected to result in a 11 meaningful reduction in abuse of opioids. 12 b. “Carrier” means an entity that provides health 13 benefit plans in this state. 14 c. “Health benefit plan” means a policy, 15 certificate, or contract providing hospital or medical 16 coverage, benefits, or services rendered by a health 17 care provider. 18 d. “Opioid analgesic drug product” means a drug 19 product in the opioid analgesic drug class prescribed 20 to treat moderate to severe pain or other conditions 21 and includes immediate release, extended release, and 22 long-acting forms, whether or not combined with other 23 drug substances to form a single drug product or dosage 24 form. 25 2. Coverage required. 26 a. Notwithstanding the uniformity of treatment 27 requirements of section 514C.6, a contract, policy, or 28 plan providing for third-party payment or prepayment 29 of health or medical expenses that provides coverage 30 benefits for opioid analgesic drug products shall 31 provide coverage for an abuse-deterrent opioid 32 analgesic drug product as a preferred drug on the 33 carrier’s drug formulary or preferred drug list. 34 b. Cost-sharing requirements for abuse-deterrent 35 -1- HF2380.2860 (1) 86 jh/nh 1/ 3 #1.

opioid analgesic drug products shall not exceed the 1 lowest cost-sharing requirements applied to other 2 covered prescription drugs on the carrier’s drug 3 formulary or preferred drug list. 4 3. Prior authorization. 5 a. A prior authorization or utilization review 6 requirement shall not require prior use of an opioid 7 analgesic drug product other than an abuse-deterrent 8 opioid analgesic drug product as a prerequisite for 9 access to an abuse-deterrent opioid analgesic drug 10 product. 11 b. This subsection shall not be construed to 12 prevent a carrier from requiring prior authorization 13 for an abuse-deterrent opioid analgesic drug product, 14 provided that the same prior authorization requirements 15 are applied to all versions of the same opioid 16 analgesic drug products that are not abuse-deterrent 17 opioid analgesic drug products. 18 4. Applicability. 19 a. This section applies to the following classes 20 of third-party payment provider contracts or policies 21 delivered, issued for delivery, continued, or renewed 22 in this state on or after July 1, 2016: 23 (1) Individual or group accident and sickness 24 insurance providing coverage on an expense-incurred 25 basis. 26 (2) An individual or group hospital or medical 27 service contract issued pursuant to chapter 509, 514, 28 or 514A. 29 (3) An individual or group health maintenance 30 organization contract regulated under chapter 514B. 31 (4) Any other entity engaged in the business of 32 insurance, risk transfer, or risk retention, which is 33 subject to the jurisdiction of the commissioner. 34 (5) A plan established pursuant to chapter 509A for 35 -2- HF2380.2860 (1) 86 jh/nh 2/ 3

public employees. 1 (6) An organized delivery system licensed by the 2 director of public health. 3 b. This section shall not apply to accident-only, 4 specified disease, short-term hospital or medical, 5 hospital confinement indemnity, credit, dental, vision, 6 Medicare supplement, long-term care, basic hospital 7 and medical-surgical expense coverage as defined 8 by the commissioner, disability income insurance 9 coverage, coverage issued as a supplement to liability 10 insurance, workers’ compensation or similar insurance, 11 or automobile medical payment insurance. > 12 2. Title page, line 1, after < relating to > by 13 inserting < drug overdose prevention, including > 14 3. Title page, line 3, by striking < victims. > and 15 inserting < victims, coverage of opioid analgesic drug 16 products, and providing an applicability date. > 17 4. By renumbering as necessary. 18 ______________________________ BAUDLER of Adair -3- HF2380.2860 (1) 86 jh/nh 3/ 3 #2. #3. #4.