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§ 15-849. Coverage requirements for abuse-deterrent opioid analgesic drug products

West's Annotated Code of MarylandInsuranceEffective: January 1, 2016

West's Annotated Code of Maryland
Insurance (Refs & Annos)
Title 15. Health Insurance
Subtitle 8. Required Health Insurance Benefits (Refs & Annos)
Effective: January 1, 2016
MD Code, Insurance, § 15-849
§ 15-849. Coverage requirements for abuse-deterrent opioid analgesic drug products
Currentness
Definitions
(a)(1) In this section the following words have the meanings indicated.
(2) “Abuse-deterrent opioid analgesic drug product” means a brand name or generic opioid analgesic drug product approved by the U.S. Food and Drug Administration with abuse-deterrent labeling that indicates the drug product is expected to result in a meaningful reduction in abuse.
(3) “Opioid analgesic drug product” means a drug product that contains an opioid agonist and is indicated by the U.S. Food and Drug Administration for the treatment of pain, regardless of whether the drug product:
(i) is in immediate release or extended release form; or
(ii) contains other drug substances.
Application of section
(b)(1) This section applies to:
(i) insurers and nonprofit health service plans that provide coverage for prescription drugs under individual, group, or blanket health insurance policies or contracts that are issued or delivered in the State; and
(ii) health maintenance organizations that provide coverage for prescription drugs under individual or group contracts that are issued or delivered in the State.
(2) An insurer, a nonprofit health service plan, or a health maintenance organization that provides coverage for prescription drugs through a pharmacy benefits manager is subject to the requirements of this section.
Coverage requirements
(c)(1) An entity subject to this section shall provide coverage for:
(i) at least two brand name abuse-deterrent opioid analgesic drug products, each containing different analgesic ingredients, on the lowest cost tier for brand name prescription drugs on the entity's formulary for prescription drug coverage; and
(ii) if available, at least two generic abuse-deterrent opioid analgesic drug products, each containing different analgesic ingredients, on the lowest cost tier for generic drugs on the entity's formulary for prescription drug coverage.
(2) An entity subject to this section may not require an insured or an enrollee to first use an opioid analgesic drug product without abuse-deterrent labeling before providing coverage for an abuse-deterrent opioid analgesic drug product covered on the entity's formulary for prescription drug coverage.
Utilization review
(d) Notwithstanding subsection (c)(2) of this section, an entity subject to this section may undertake utilization review, including preauthorization, for an abuse-deterrent opioid analgesic drug product covered by the entity, if the same utilization review requirements are applied to non-abuse-deterrent opioid analgesic drug products covered by the entity in the same formulary tier as the abuse-deterrent opioid analgesic product.

Credits

Added by Acts 2015, c. 372, § 1, eff. Jan. 1, 2016.
MD Code, Insurance, § 15-849, MD INSURANCE § 15-849
Current with legislation effective through October 1, 2024, from the 2024 Regular Session of the General Assembly. Some statute sections may be more current, see credits for details.
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