Health insurance; coverage for non-opioid prescription drugs.

Plain English Breakdown

The bill summary text specifies that health insurance carriers cannot impose more restrictive or less favorable conditions on non-opioid drugs compared to opioids, but it does not mandate identical treatment for both types of drugs.

Health Insurance Coverage for Non-Opioid Pain Medicines

This law requires health insurance companies to treat non-opioid pain medicines no less favorably than opioid pain medicines in terms of coverage and costs.

What This Bill Does

• It prohibits health insurance companies from imposing more restrictive or less favorable cost-sharing, prior authorization, step therapy, or other limitations on the coverage of covered non-opioid drugs compared to covered opioid drugs for pain management.
• This applies to individual and group health insurance policies that cover prescription drugs.

Who It Names or Affects

• People with health insurance who need prescription drugs for pain management.
• Insurance companies that offer policies covering prescription drugs.

Terms To Know

Cost-sharing

The part of the medical costs that a person has to pay out-of-pocket, like copayments or coinsurance.

Prior authorization

A requirement by an insurance company for approval before covering certain treatments or medications.

Step therapy

A process where a patient must try and fail at least one less expensive treatment before getting coverage for a more costly medication.

Limits and Unknowns

• The law only applies to insurance policies, contracts, and plans delivered or renewed in Virginia on or after January 1, 2027.
• It does not specify what happens if an insurer violates the new rules.

Official Summary Text

Health insurance; coverage for non-opioid prescription drugs.
Prohibits a health insurance carrier from imposing any cost-sharing, prior authorization, step therapy, or other limitation on coverage of a covered non-opioid drug approved by the U.S. Food and Drug Administration for the treatment or management of pain that is more restrictive or less favorable to the enrollee relative to a covered opioid drug approved by the U.S. Food and Drug Administration for the treatment or management of pain.

Current Bill Text

A BILL to amend the Code of Virginia by adding a section numbered
38.2-3407.9:06
, relating to health insurance; coverage for non-opioid prescription drugs.

Be it enacted by the General Assembly of Virginia:

1. That the Code of Virginia is amended by adding a section numbered
38.2-3407.9:06
as follows:

§
38.2-3407.9:0
6
.
Coverage for non-opioid
prescription drugs
.

No
twithstanding the provisions of §
38.2-3419
or subdivision A 1 of §
38.2-6506
, no
(i) insurer proposing to issue individual or group accident and sickness insurance policies providing hospital, medical
,
and surgical or major medical coverage on an expense-incurred basis
;
(ii) corporation providing individual or group accident and sickness subscription contracts
;
or (iii) health maintenance organization providing a health care plan for health care services whose policy, contract
,
or plan, including any certificate or evidence of coverage issued in connection with such policy, contract
,
or plan, includes coverage for prescription drugs shall
impose any
cost-sharing,
prior authorization, step therapy, or other limitation on coverage of a covered non-opioid drug approved
by the U.S. Food and Drug Administration
for the treatment
or management
of pain that
is

more restrictive or
less favorable to the enrollee
relative to a covered opioid drug
approved by the U.S. Food and Drug Administration
for the treatment or management of pain
.

2. That the provisions of this act shall apply to insurance policies, contracts, and plans delivered, issued for delivery, or renewed in the Commonwealth on and after January 1, 2027.