Bill Summaries: H1048 (2015-2016 Session)

  • Summary date: May 5 2016 - View summary

    Includes various whereas clauses concerning opioid-related deaths and health concerns in North Carolina. 

    Enacts new GS 58-3-295 concerning coverage for abuse-deterrent opioid analgesics. Sets out and defines abuse-deterrent opioid analgesic drug product, health benefit plan, and opioid for use in this statute. Further provides that health benefit plans that provide coverage for abuse-deterrent opioid analgesic drug products can impose a prior authorization requirement only if the health benefit plan imposes the same prior authorization requirement for each opioid analgesic drug product without an abuse-deterrence labeling claim. Prohibits a health benefit plan covering abuse-deterrent opiod analgesic drug products from requiring the use of an opioid analgesic drug product without an abuse-deterrence labeling claim before authorizing the use of an abuse-deterent opioid analgesic drug product.

    Enacts new GS Chapter 58, Article 50, Part 8, Administration of Step Therapy Protocols, setting out the following five terms and definitions for use in the Article: clinical practice guidelines, clinical review criteria, step therapy override determination, step therapy protocol, and utilization review organization. Requires clinical review criteria used to establish step therapy protocol to be based on clinical practice guidelines that meet the five specified requirements. Defines step therapy protocol as a protocol or program that establishes the specific sequence in which prescription drugs for a specified medical condition are medically appropriate for a particular patient and are covered by an insurer or health plan. Requires that the patient and prescribing practitioner have access to a clear and convenient process for requesting a step therapy override determination when coverage for a prescription drug is restricted for use by a health benefit plan or utilization review organization through the use of a step therapy protocol. Sets out four conditions under which a step therapy override determination request must be expeditiously granted. Requires that when an override determination is granted, the health plan or utilization review organization authorize coverage for the prescribed drug if it is a covered prescription.

    Effective October 1, 2016, and applies to health benefit contracts issued, renewed, or amended on or after that date.