Section 376.1280

Title XXIV BUSINESS AND FINANCIAL INSTITUTIONS

Chapter 376

Effective - 28 Aug 2026, see footnote   

  376.1280.  Definitions — nonopioid medications prescribed for pain — health benefit plan prohibited acts — applicability. — 1.  As used in this section, the following terms mean:

  (1)  "Acute pain", pain that results from disease, accidental or intentional trauma, or other causes, that a health care provider reasonably expects to last thirty days or fewer;

  (2)  "Chronic pain", pain that is a persistent and long-lasting condition characterized by discomfort or pain that lasts for more than twelve weeks, often persisting beyond the expected healing time.  It may result from various causes including, but not limited to, injury, surgery, nerve damage, or underlying medical conditions;

  (3)  "Enrollee", the same meaning given to the term in section 376.1350;

  (4)  "Health benefit plan", the same meaning given to the term in section 376.1350;

  (5)  "Health care professional", the same meaning given to the term in section 376.1350.

  2.  Notwithstanding any provision of law to the contrary, when a licensed health care professional acting within the scope of his or her license prescribes a nonopioid medication for the treatment of acute or chronic pain to an enrollee, it shall be unlawful for a health benefit plan to:

  (1)  Deny coverage of the nonopioid prescription drug in favor of an opioid prescription drug;

  (2)  Require the enrollee to try an opioid prescription drug before providing coverage of the nonopioid prescription drug; or

  (3)  Require a higher level of cost-sharing for the nonopioid prescription drug than for an opioid prescription drug.

  3.  This section shall apply to health benefit plans delivered, issued for delivery, continued, or renewed on or after January 1, 2027.

  4.  The provisions of this section related to the treatment of acute pain shall be applicable only when multiple nonopioid medications are approved by the U.S. Food and Drug Administration and indicated for the treatment of acute pain.

  5.  The provisions of this section related to the treatment of chronic pain shall be applicable only when multiple nonopioid medications are approved by the U.S. Food and Drug Administration and indicated for the treatment of chronic pain.

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(L. 2026 S.B. 878)