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7 LONG TITLE
8 General Description:
9 This bill requires commercial insurers, the state Medicaid program, workers'
10 compensation insurers, and public employee insurers to implement policies to minimize
11 the risk of prescribing certain controlled substances.
12 Highlighted Provisions:
13 This bill:
14 ▸ defines terms;
15 ▸ requires a health insurance policy, a health plan offered to state employees, the
16 Medicaid program, and workers' compensation insurance to establish policies for
17 prescribing certain controlled substances;
18 ▸ applies to insurance plans entered into or renewed on or after July 1, 2017;
19 ▸ requires a report to the Health and Human Services Interim Committee; and
20 ▸ sunsets the requirement for prescribing policies on July 1, 2022.
21 Money Appropriated in this Bill:
22 None
23 Other Special Clauses:
24 None
25 Utah Code Sections Affected:
26 AMENDS:
27 63I-1-231, as last amended by Laws of Utah 2015, Chapter 50
28 ENACTS:
29 26-18-21, Utah Code Annotated 1953
30 31A-22-615, Utah Code Annotated 1953
31 34A-2-424, Utah Code Annotated 1953
32 49-20-414, Utah Code Annotated 1953
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34 Be it enacted by the Legislature of the state of Utah:
35 Section 1. Section 26-18-21 is enacted to read:
36 26-18-21. Prescribing policies for opioid prescriptions.
37 (1) The department shall implement a prescribing policy for certain opioid
38 prescriptions that is substantially similar to the prescribing policies required in Section
39 31A-22-615.
40 (2) The department may amend the state program and apply for waivers for the state
41 program, if necessary, to implement Subsection (1).
42 Section 2. Section 31A-22-615 is enacted to read:
43 31A-22-615. Insurance coverage for opioids -- Policies -- Reports.
44 (1) For purposes of this section:
45 (a) "Health care provider" means an individual, other than a veterinarian, who:
46 (i) is licensed to prescribe a controlled substance under Title 58, Chapter 37, Utah
47 Controlled Substances Act; and
48 (ii) possesses the authority, in accordance with the individual's scope of practice, to
49 prescribe Schedule II controlled substances and Schedule III controlled substances that are
50 applicable to opioids and benzodiazapines.
51 (b) "Health insurer" means:
52 (i) an insurer who offers health care insurance as that term is defined in Section
53 31A-1-301;
54 (ii) health benefits offered to state employees under Section 49-20-202; and
55 (iii) a workers' compensation insurer:
56 (A) authorized to provide workers' compensation insurance in the state; or
57 (B) that is a self-insured employer as defined in Section 34A-2-201.
58 (c) "Opioid" has the same meaning as "opiate," as that term is defined in Section
59 58-37-2.
60 (d) "Prescribing policy" means a policy developed by a health insurer that includes
61 evidence based guidelines for prescribing opioids, and may include the 2016 Center for Disease
62 Control Guidelines for Prescribing Opioids for Chronic Pain, or the 2016 Utah Opioid
63 Prescribing Guidelines.
64 (2) A health insurer that provides prescription drug coverage shall enact a prescribing
65 policy to minimize the risk of opioid addiction and overdose from:
66 (a) co-prescription of opioids with benzodiazapines and other sedating substances;
67 (b) prescription of very high dose opioids in the primary care setting; and
68 (c) the inadvertent transition of short-term opioids for an acute injury into long-term
69 opioid dependance.
70 (3) A health insurer that provides prescription drug coverage shall enact policies to
71 facilitate:
72 (a) non-narcotic treatment alternatives for patients who have chronic pain; and
73 (b) medication-assisted treatment for patients who have opioid dependence disorder.
74 (4) The requirements of this section apply to insurance plans entered into or renewed
75 on or after July 1, 2017.
76 (5) A health insurer subject to this section shall on or before October 1, 2018, and
77 before each October 1 thereafter, report to the Health and Human Services Interim Committee
78 regarding:
79 (a) the health insurer's opioid policies as described in Subsections (2) and (3); and
80 (b) the health insurer's analysis of whether the prescribing policy has been effective in
81 reducing the risk of opioid addictions and overdoses.
82 (5) This section sunsets in accordance with Section 63I-1-231.
83 Section 3. Section 34A-2-424 is enacted to read:
84 34A-2-424. Prescribing policies for certain opioid prescriptions.
85 (1) This section applies to a person regulated by this chapter or Chapter 3, Utah
86 Occupational Disease Act.
87 (2) A self-insured employer, as that term is defined in Section 34A-2-201.5, an
88 insurance carrier, and a managed health care program under Section 34A-2-111 shall
89 implement a prescribing policy for certain opioid prescriptions in accordance with Section
90 31A-22-615.
91 Section 4. Section 49-20-414 is enacted to read:
92 49-20-414. Prescribing policies for certain opioid prescriptions.
93 A plan offered to state employees under this chapter shall implement a prescribing
94 policy for certain opioid prescriptions in accordance with Section 31A-22-615.
95 Section 5. Section 63I-1-231 is amended to read:
96 63I-1-231. Repeal dates, Title 31A.
97 (1) Section 31A-2-217, Coordination with other states, is repealed July 1, 2023.
98 (2) Section 31A-22-615 is repealed July 1, 2022.
99 [
100 claim--Health insurer's duty to pay, is repealed on July 1, 2018.
101 [
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103 (4) Section 31A-22-642, Insurance coverage for autism spectrum disorder, is repealed
104 on January 1, 2019.
Legislative Review Note
Office of Legislative Research and General Counsel