Sec. 17. Educational outreach and access to abuse-deterrent opioids

395 words·~2 min read·/bill/115/s/2789/rs/section-17

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Section 1860D–4(c) of the Social Security Act ( 42 U.S.C. 1395w–104(c) ) is amended by adding at the end the following new paragraph: The Secretary shall work with PDP sponsors of prescription drug plans to— ensure appropriate access to abuse-deterrent opioids on plan formularies; provide advanced abuse-deterrent opioid targeting (as determined by the Secretary) for beneficiaries identified as at-risk for opioid abuse under the drug management program under paragraph

(5)or any other opioid risk management program established by the sponsor; and encourage access to non-opioid alternatives when medically appropriate. The Secretary shall prohibit PDP sponsors from requiring fail first schemes, also known as step therapy, with respect to abuse-deterrent opioids. The Secretary shall encourage plans to provide equal access to abuse-deterrent opioids on formulary tiers and patient cost-sharing. In this paragraph, the term abuse-deterrent opioid means an abuse-deterrent formulation of an opioid, as determined by the Secretary. . Subpart II of title XXVII of the Public Health Service Act ( 42 U.S.C. 300gg–11 et seq.) is amended by adding at the end the following: A group health plan and a health insurance issuer offering group or individual health insurance coverage shall— ensure appropriate access to abuse-deterrent opioids as a prescription drug health benefit under such plan or coverage; provide advanced abuse-deterrent opioid targeting (as determined by the Secretary) for enrollees in the plan or coverage who are identified as at-risk for opioid abuse; and encourage access to non-opioid alternatives when medically appropriate. The Secretary shall prohibit a group health plan and a health insurance issuer offering group or individual health insurance coverage from requiring fail first schemes, also known as step therapy, with respect to abuse-deterrent opioids. In this section, the term abuse-deterrent opioid means an abuse-deterrent formulation of an opioid, as determined by the Secretary. . The amendments made by this subsection shall apply with respect to plan years beginning on or after January 1, 2019. The Secretary of Health and Human Services shall educate health insurance issuers, Medicare Advantage plans under part C of title XVIII of the Social Security Act ( 42 U.S.C. 1395w–21 et seq.), and prescription drug plans under part D of such title ( 42 U.S.C. 1395w–101 et seq.) on opioid abuse prevention, including the use of abuse-deterrent opioids (as such term is defined in section 2729 of the Public Health Service Act, as added by subsection (a)(2)).

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42 USC 1395w–104(c)
42 USC 300gg–11
42 USC 1395w–21
42 USC 1395w–101

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Sec. 17

Educational outreach and access to abuse-deterrent opioids

Cite42 USC 1395w–104(c)

Cite42 USC 300gg–11

Cite42 USC 1395w–21

Cite42 USC 1395w–101

Cites 4Cited by 0 across 0 sources