HB326: HB326 State Health Benefit Plan Nonopioid Coverage Parity Act; enact

26 LC 46 1473S The House Committee on Health offers the following substitute to HB 326: A BILL TO BE ENTITLED AN ACT To amend Article 1 of Chapter 18 of Title 45 of the Official Co de of Georgia Annotated,1 relating to state employees' health insurance plan and post-employment health benefit fund,2 so as to mandate that the state health benefit plan provide coverage for qualifying nonopioid3 pain management drugs in parity with its coverage for opioid pa in management drugs; to4 provide for definitions; to provide for parity with regard to annual deductibles, coinsurance,5 copayments, exclusions, reductions, other limitations, or utili zation review; to provide for6 legislative construction; to provide for related matters; to provide for a short title; to provide7 for legislative findings and declarations; to provide for an effective date; to repeal conflicting8 laws; and for other purposes.9 BE IT ENACTED BY THE GENERAL ASSEMBLY OF GEORGIA:10 SECTION 1.11 This Act shall be known and may be cited as the "State Health B enefit Plan Nonopioid12 Coverage Parity Act."13 SECTION 2.14 The General Assembly finds and declares that:15 H. B. 326 (SUB) - 1 - 26 LC 46 1473S (1) An opioid epidemic has cost the state millions of dollars in medical treatment, lost16 economic productivity, and increased overdose deaths, among other costs; and17 (2) Requiring coverage for nonopioid pain management drugs in the state health benefit18 plan that is at least as good as its coverage for opioid pain management drugs will reduce19 the costs borne by this state. 20 SECTION 3.21 Article 1 of Chapter 18 of Title 45 of the Official Code of Geo rgia Annotated, relating to22 state employees' health insurance plan and post-employment health benefit fund, is amended23 by adding a new Code section to read as follows:24 "45-18-4.3.25 (a) As used in this Code section, the term:26 (1) 'Healthcare provider' means the pharmacy, attending physician, or any other person27 or entity administering healthcare to a member of the state health benefit plan at the time28 of reference that is licensed, certified, or otherwise authoriz ed or permitted by law to29 administer healthcare in the ordinary course of business or pra ctice of a profession,30 including any person employed by or acting for any such authorized person or entity.31 (2) 'Prior authorization' means any requirement for the health care provider to obtain32 approval from the state health benefit plan prior to the furnishing of a drug.33 (3) 'Qualifying nonopioid pain management drugs' means a drug or biological product34 that:35 (A) Has a label indication approved by the federal Food and Drug Administration to36 reduce postoperative pain or any other form of acute pain;37 (B) Does not act upon the body's opioid receptors;38 (C) Is not a Schedule I or II controlled substance;39 (D) Has been selected by the Department of Community Health fo r inclusion in its40 formulary; and41 H. B. 326 (SUB) - 2 - 26 LC 46 1473S (E) Is sold or marketed in the United States.42 (4) 'State health benefit plan' means the health insurance plan established pursuant to this43 article.44 (5) 'Step therapy' means a drug therapy utilization management protocol or program that45 requires use of an alternative, preferred prescription drug or drugs before the state health46 benefit plan approves coverage for the nonpreferred drug therapy prescribed.47 (b) The state health benefit plan shall cover qualifying nonopioid pain management drugs48 and such drugs shall be subject to the same annual deductible, coinsurance, copayment,49 exclusions, reductions, or other limitations as to coverage, or utilization review applicable50 to similar covered opioid pain management drugs.51 (c) Notwithstanding subsection (b) of this Code section, nothing in this Code section shall52 be construed to prohibit the state health benefit plan from contracting to provide qualifying53 nonopioid pain management drug coverage for the state health benefit plan that is greater54 than the coverage provided for opioid pain management drugs.55 ( d ) T h e s t a t e h e a l t h b e n e f i t p l a n s h a l l , w i t h r e s p e c t t o a q u alifying nonopioid pain56 management drug for which coverage is provided under such plan, neither impose any step57 therapy requirement under which an individual enrolled under such plan is required to use58 an opioid pain management drug prior to receiving the prescribe d qualifying nonopioid59 pain management drug nor require prior authorization for qualif ying nonopioid pain60 management drugs unless similar prior authorization is required for opioid pain61 management drugs.62 (e) Nothing in this Code section should be construed to interf ere with the ability of a63 healthcare provider to prescribe or administer a course of trea tment that is medically64 appropriate."65 SECTION 4.66 This Act shall become effective on January 1, 2027.67 H. B. 326 (SUB) - 3 - 26 LC 46 1473S SECTION 5.68 All laws and parts of laws in conflict with this Act are repealed.69 H. B. 326 (SUB) - 4 -