Opioid and Step-Therapy Protections

Abuse-deterrent opioids: a policy covering abuse-deterrent opioid analgesics may impose prior authorization ONLY if the identical requirement applies to every opioid without an abuse-deterrence claim — and may not force the insured to try a non-abuse-deterrent opioid first. Step-therapy exception: an insurer may NOT require a step-therapy protocol for a requested drug if the insured (1) already completed a step-therapy protocol for it under a separate health plan and (2) supplies documentation from that plan showing it paid for the drug during the ninety (90) days immediately before the request. This forces no drug onto the formulary and requires no coverage of drugs the insurer doesn't otherwise cover.

No "fail first on the riskier pill," and no re-running the fail-first ladder you already climbed at your last plan — bring 90 days of payment proof.