SECTION 627.64195. Requirements for opioid coverage.
Latest version.
1(1) 2DEFINITIONS.3-4As used in this section, the term:
11(a) 12“Abuse-deterrent opioid analgesic drug product” means a brand or generic opioid analgesic drug product approved by the United States Food and Drug Administration with an abuse-deterrence labeling claim that indicates the drug product is expected to deter abuse.
50(b) 51“Opioid analgesic drug product” means a drug product in the opioid analgesic drug class prescribed to treat moderate to severe pain or other conditions in immediate-release, extended-release, or long-acting form regardless of whether or not combined with other drug substances to form a single drug product or dosage form.
100(2) 101COVERAGE REQUIREMENTS.103-104A health insurance policy that provides coverage for abuse-deterrent opioid analgesic drug products:
117(a) 118May impose a prior authorization requirement for an abuse-deterrent opioid analgesic drug product only if the policy imposes the same prior authorization requirement for each opioid analgesic drug product without an abuse-deterrence labeling claim.
152(b) 153May not require use of an opioid analgesic drug product without an abuse-deterrence labeling claim before authorizing the use of an abuse-deterrent opioid analgesic drug product.
