AB 499

This bill requires health care insurance plans and self-insured governmental health plans that provide drug coverage to develop and implement a pain management access plan to ensure adequate coverage and access to a broad spectrum of pain management alternatives to opioid drugs. Under the bill, the health care plan or self-insured plan must provide coverage for at least two prescription medication treatment options that are approved by the U.S. Food and Drug Administration for the treatment or management of pain and are not schedule I, II, or III controlled substances. The health care plan or self-insured plan must also provide coverage for at least three alternative nonpharmacological treatment modalities. The bill prohibits the health care plan or self-insured plan from establishing utilization controls for clinically appropriate, FDA-approved nonopioid drugs or drug products that are more restrictive or extensive than utilization controls applicable to an opioid or narcotic drug. Also under the bill, the health care plan or self-insured plan must provide information about the pain management access plan to enrollees and health care providers and make the plan publicly available on its website.

The bill prohibits the Department of Health Services from disadvantaging or discouraging the inclusion on its preferred drug list of a nonopioid drug that is approved by the FDA for the treatment or management of pain relative to the inclusion of an opioid or narcotic drug for the treatment or management of pain.

This proposal may contain a health insurance mandate requiring a social and financial impact report under s. 601.423, stats.