AN ACT RELATING TO INSURANCE -- ACCIDENT AND SICKNESS INSURANCE POLICIES (Requires insurers to develop plans for coverage and access to nonnarcotic, nonopioid and nonmedication pain management for moderate to severe pain. It further restricts utilization review for nonopioid drugs.)

S3022

2026 -- S 3022
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LC005923
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STATE OF RHODE ISLAND
IN GENERAL ASSEMBLY
JANUARY SESSION, A.D. 2026
____________
A N A C T
RELATING TO INSURANCE -- ACCIDENT AND SICKNESS INSURANCE POLICIES

Introduced By:
Senators Bissaillon, Murray, DiMario, and DiPalma

Date Introduced:
March 05, 2026

Referred To:
Senate Health & Human Services
It is enacted by the General Assembly as follows:
1
SECTION 1. Chapter 27-18 of the General Laws entitled "Accident and Sickness Insurance
2
Policies" is hereby amended by adding thereto the following section:
3

27-18-96. Access to pain management services.

4

(a) Every individual or group health insurance contract, plan, or policy that provides
5
prescription coverage and that is delivered, issued for delivery, prescribed, or renewed in this state
6
on or after January 1, 2027, shall develop a plan to provide adequate coverage of and access to a
7
broad spectrum of pain management services including, but not limited to, nonopioid, nonnarcotic
8
medication for pain management and nonmedication pain management services that serve as
9
alternatives to the prescribing of opioid or narcotic drugs in accordance with guidelines developed
10
by the office of the health insurance commissioner.
11

(b)(1) Approval by health insurance commissioner. Every individual or group health
12
insurance carrier shall file a plan required under subsection (a) of this section with the
13
commissioner for approval. In its review, the commissioner shall consider the adequacy of access
14
to a broad spectrum of pain management services under the plan and whether any policies adopted
15
by the carrier may create unduly preferential coverage of and access to prescribed opioids for pain
16
management without consideration of other pain management services.
17

(2) No individual or group health insurance contract, plan, or policy that provides
18
prescription coverage and that is delivered, issued for delivery, prescribed, or renewed in this state
19
on or after January 1, 2027 shall apply any utilization review, including without limitation, prior

1
authorization or step therapy protocols, for clinically appropriate nonopioid prescription drugs
2
approved by the United States Food and Drug Administration for the treatment or management of
3
moderate to severe pain, that is more restrictive or extensive than the least restrictive or extensive
4
utilization review applicable to any clinically appropriate opioid or narcotic drug.
5

(c) Information for enrollees. Every individual or group health insurance carrier shall
6
distribute educational materials to network providers about a pain management access plan under
7
subsection (a) of this section and post information about the pain management access plan on the
8
carrier's publicly accessible website.
9
SECTION 2. Chapter 27-19 of the General Laws entitled "Nonprofit Hospital Service
10
Corporations" is hereby amended by adding thereto the following section:
11

27-19-88. Access to pain management services.

12

(a) Every individual or group health insurance contract, plan, or policy that provides
13
prescription coverage and that is delivered, issued for delivery, prescribed, or renewed in this state
14
on or after January 1, 2027, shall develop a plan to provide adequate coverage of and access to a
15
broad spectrum of pain management services including, but not limited to, nonopioid, nonnarcotic
16
medication for pain management and nonmedication pain management services that serve as
17
alternatives to the prescribing of opioid or narcotic drugs in accordance with guidelines developed
18
by the office of the health insurance commissioner.
19

(b)(1) Approval by health insurance commissioner. Every individual or group health
20
insurance carrier shall file a plan required under subsection (a) of this section with the
21
commissioner for approval. In its review, the commissioner shall consider the adequacy of access
22
to a broad spectrum of pain management services under the plan and whether any policies adopted
23
by the carrier may create unduly preferential coverage of and access to prescribed opioids for pain
24
management without consideration of other pain management services.
25

(2) No individual or group health insurance contract, plan, or policy that provides
26
prescription coverage and that is delivered, issued for delivery, prescribed, or renewed in this state
27
on or after January 1, 2027 shall apply any utilization review, including without limitation, prior
28
authorization or step therapy protocols, for clinically appropriate nonopioid prescription drugs
29
approved by the United States Food and Drug Administration for the treatment or management of
30
moderate to severe pain, that is more restrictive or extensive than the least restrictive or extensive
31
utilization review applicable to any clinically appropriate opioid or narcotic drug.
32

(c) Information for enrollees. Every individual or group health insurance carrier shall
33
distribute educational materials to network providers about a pain management access plan under
34
subsection (a) of this section and post information about the pain management access plan on the

LC005923 - Page 2 of 6
1
carrier's publicly accessible website.
2
SECTION 3. Chapter 27-20 of the General Laws entitled "Nonprofit Medical Service
3
Corporations" is hereby amended by adding thereto the following section:
4

27-20-84. Access to pain management services.

5

(a) Every individual or group health insurance contract, plan, or policy that provides
6
prescription coverage and that is delivered, issued for delivery, prescribed, or renewed in this state
7
on or after January 1, 2027, shall develop a plan to provide adequate coverage of and access to a
8
broad spectrum of pain management services including, but not limited to, nonopioid, nonnarcotic
9
medication for pain management and nonmedication pain management services that serve as
10
alternatives to the prescribing of opioid or narcotic drugs in accordance with guidelines developed
11
by the office of the health insurance commissioner.
12

(b)(1) Approval by health insurance commissioner. Every individual or group health
13
insurance carrier shall file a plan required under subsection (a) of this section with the
14
commissioner for approval. In its review, the commissioner shall consider the adequacy of access
15
to a broad spectrum of pain management services under the plan and whether any policies adopted
16
by the carrier may create unduly preferential coverage of and access to prescribed opioids for pain
17
management without consideration of other pain management services.
18

(2) No individual or group health insurance contract, plan, or policy that provides
19
prescription coverage and that is delivered, issued for delivery, prescribed, or renewed in this state
20
on or after January 1, 2027 shall apply any utilization review, including without limitation, prior
21
authorization or step therapy protocols, for clinically appropriate nonopioid prescription drugs
22
approved by the United States Food and Drug Administration for the treatment or management of
23
moderate to severe pain, that is more restrictive or extensive than the least restrictive or extensive
24
utilization review applicable to any clinically appropriate opioid or narcotic drug.
25

(c) Information for enrollees. Every individual or group health insurance carrier shall
26
distribute educational materials to network providers about a pain management access plan under
27
subsection (a) of this section and post information about the pain management access plan on the
28
carrier's publicly accessible website.
29
SECTION 4. Chapter 27-41 of the General Laws entitled "Health Maintenance
30
Organizations" is hereby amended by adding thereto the following section:
31

27-41-101. Access to pain management services.

32

(a) Every individual or group health insurance contract, plan, or policy that provides
33
prescription coverage and that is delivered, issued for delivery, prescribed, or renewed in this state
34
on or after January 1, 2027, shall develop a plan to provide adequate coverage of and access to a

LC005923 - Page 3 of 6
1
broad spectrum of pain management services including, but not limited to, nonopioid, nonnarcotic
2
medication for pain management and nonmedication pain management services that serve as
3
alternatives to the prescribing of opioid or narcotic drugs in accordance with guidelines developed
4
by the office of the health insurance commissioner.
5

(b)(1) Approval by health insurance commissioner. Every individual or group health
6
insurance carrier shall file a plan required under subsection (a) of this section with the
7
commissioner for approval. In its review, the commissioner shall consider the adequacy of access
8
to a broad spectrum of pain management services under the plan and whether any policies adopted
9
by the carrier may create unduly preferential coverage of and access to prescribed opioids for pain
10
management without consideration of other pain management services.
11

(2) No individual or group health insurance contract, plan, or policy that provides
12
prescription coverage and that is delivered, issued for delivery, prescribed, or renewed in this state
13
on or after January 1, 2027 shall apply any utilization review, including without limitation, prior
14
authorization or step therapy protocols, for clinically appropriate nonopioid prescription drugs
15
approved by the United States Food and Drug Administration for the treatment or management of
16
moderate to severe pain, that is more restrictive or extensive than the least restrictive or extensive
17
utilization review applicable to any clinically appropriate opioid or narcotic drug.
18

(c) Information for enrollees. Every individual or group health insurance carrier shall
19
distribute educational materials to network providers about a pain management access plan under
20
subsection (a) of this section and post information about the pain management access plan on the
21
carrier's publicly accessible website.
22
SECTION 5. Chapter 40-21 of the General Laws entitled "Medical Assistance —
23
Prescription Drugs" is hereby amended by adding thereto the following section:
24

40-21-4. Access to nonopioid pain treatment.

25

(a) The Rhode Island medical assistance program, as defined under chapter 8 of this title,
26
and any contract between the Rhode Island medical assistance program and a managed care
27
organization, shall not apply any utilization review, including without limitation prior authorization
28
or step therapy protocols, for clinically appropriate nonopioid prescription drugs approved by the
29
United States Food and Drug Administration for the treatment or management of moderate to
30
severe pain, that is more restrictive or extensive than the least restrictive or extensive utilization
31
review applicable to any clinically appropriate opioid or narcotic drug.
32

(b) The Rhode Island medical assistance program shall require, through amending current
33
and future medical assistance managed care contracts, that managed care organizations meet the
34
provisions of this section.

LC005923 - Page 4 of 6
1

(c) This section applies to all policies, contracts, and plans executed, delivered, issued for
2
delivery, continued or renewed in this state on or after January 1, 2027.
3
SECTION 6. This act shall take effect upon passage.
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LC005923 - Page 5 of 6
EXPLANATION
BY THE LEGISLATIVE COUNCIL
OF
A N A C T
RELATING TO INSURANCE -- ACCIDENT AND SICKNESS INSURANCE POLICIES
***
1
This act would require insurers to develop plans for coverage and access to nonnarcotic,
2
nonopioid and nonmedication pain management for moderate to severe pain. This act would further
3
restrict utilization review for nonopioid drugs.
4
This act would take effect upon passage.
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LC005923
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LC005923 - Page 6 of 6