RI 2026 H7628: Insurance - Accident and Sickness Insurance Policies- Non-Opioid Pain Treatment

Plain-English Summary

This legislation mandates that individual and group health insurance carriers in Rhode Island develop plans to provide coverage for a wide range of pain management services. Specifically, these policies, effective on or after January 1, 2027, must include access to non-opioid and non-narcotic medications and alternative treatments. Insurance carriers are required to submit these plans to the Health Insurance Commissioner for approval to ensure they do not unfairly favor opioids. Additionally, carriers must educate network providers about these plans and post the information on their public websites.

For younger readers

Sometimes when people hurt, doctors give them strong medicine that can be dangerous if used too much. This new law tells health insurance companies that they must help pay for different ways to stop pain that do not use those strong medicines. By the year 2027, these companies must have a plan to pay for safer options like different medicines or treatments. They also have to tell doctors and put information on their websites so everyone knows they have safer choices to help them feel better.

Who & Where It Applies

Impacted groups

Health insurance carriersPatients with chronic painHealthcare providersPharmacistsPhysical therapists

Impacted communities

All

Constitutional & Fiscal Check

None Likely

Estimated cost

None

Estimated revenue

None

Bill Analysis

Both viewpoints

For Progressives

Addresses the opioid epidemic by mandating coverage for safer, non-addictive pain management alternatives, potentially saving lives and reducing substance abuse in vulnerable communities.
Increases corporate accountability by requiring insurance carriers to submit plans for government approval, ensuring they prioritize patient health over the low cost of generic opioids.
Expands access to holistic and non-pharmaceutical healthcare options, which are often inaccessible to lower-income individuals due to lack of insurance coverage.
Delays implementation until January 1, 2027, leaving a significant gap of time where patients may continue to struggle with limited access to non-opioid alternatives.
Uses subjective language like "adequate coverage," which insurance companies might exploit to provide the bare minimum of alternative services rather than comprehensive care.
Lacks specific provisions to prevent insurance companies from raising premiums to offset the costs of these new treatments, which could financially burden working-class families.

For Conservatives

Supports the fight against drug addiction and promotes social stability by encouraging medical treatments that do not lead to dependency on narcotics.
Increases transparency by requiring insurance carriers to post their pain management access plans on public websites for consumers to review.
May stimulate market demand for innovative medical technologies and non-pharmaceutical therapies by ensuring they are reimbursable services.
Imposes heavy government mandates on private businesses, dictating exactly what services insurance companies must offer regardless of their business model.
Expands the size and scope of the administrative state by giving the Health Insurance Commissioner more power to approve or reject private business plans.
Likely to increase insurance premiums for all policyholders as carriers pass on the costs of covering more expensive, non-generic pain treatments.

Votes

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Full Bill Text

Changes to existing Rhode Island law · 72 additions

SECTION 1. Chapter 27-18 of the General Laws entitled "Accident and Sickness Insurance Policies" is hereby amended by adding thereto the following section: 27-18-96. Access to pain management services.

(a) Every individual or group health insurance contract, plan, or policy that provides prescription coverage and that is delivered, issued for delivery, prescribed, or renewed in this state on or after January 1, 2027, shall develop a plan to provide adequate coverage of and access to a broad spectrum of pain management services including, but not limited to, nonopioid, nonnarcotic medication for pain management and nonmedication pain management services that serve as alternatives to the prescribing of opioid or narcotic drugs in accordance with guidelines developed by the bureau.

(b) Approval by health insurance commissioner. Every individual or group health insurance carrier shall file a plan required under subsection (a) of this section with the commissioner for approval. In its review, the commissioner shall consider the adequacy of access to a broad spectrum of pain management services under the plan and whether any policies adopted by the carrier may create unduly preferential coverage of and access to prescribed opioids for pain management without consideration of other pain management services.

(c) Information for enrollees. Every individual or group health insurance carrier shall distribute educational materials to network providers about a pain management access plan under subsection (a) of this section and post information about the pain management access plan on the carrier's publicly accessible website.

SECTION 2. Chapter 27-19 of the General Laws entitled "Nonprofit Hospital Service Corporations" is hereby amended by adding thereto the following section: 27-19-88. Access to pain management services.

(a) Every individual or group health insurance contract, plan, or policy that provides prescription coverage and that is delivered, issued for delivery, prescribed, or renewed in this state on or after January 1, 2027, shall develop a plan to provide adequate coverage of and access to a broad spectrum of pain management services including, but not limited to, nonopioid, nonnarcotic medication for pain management and nonmedication pain management services that serve as alternatives to the prescribing of opioid or narcotic drugs in accordance with guidelines developed by the bureau.

(b) Approval by health insurance commissioner. Every individual or group health insurance carrier shall file a plan required under subsection (a) of this section with the commissioner for approval. In its review, the commissioner shall consider the adequacy of access to a broad spectrum of pain management services under the plan and whether any policies adopted by the carrier may create unduly preferential coverage of and access to prescribed opioids for pain management without consideration of other pain management services.

(c) Information for enrollees. Every individual or group health insurance carrier shall distribute educational materials to network providers about a pain management access plan under subsection (a) and post information about the pain management access plan on the carrier's publicly accessible website.

SECTION 3. Chapter 27-20 of the General Laws entitled "Nonprofit Medical Service Corporations" is hereby amended by adding thereto the following section: 27-20-84. Access to pain management services.

(a) Every individual or group health insurance contract, plan, or policy that provides prescription coverage and that is delivered, issued for delivery, prescribed, or renewed in this state on or after January 1, 2027, shall develop a plan to provide adequate coverage of and access to a broad spectrum of pain management services including, but not limited to, nonopioid, nonnarcotic medication for pain management and nonmedication pain management services that serve as alternatives to the prescribing of opioid or narcotic drugs in accordance with guidelines developed by the bureau.

(b) Approval by health insurance commissioner. Every individual or group health insurance carrier shall file a plan required under subsection (a) of this section with the commissioner for approval. In its review, the commissioner shall consider the adequacy of access to a broad spectrum of pain management services under the plan and whether any policies adopted by the carrier may create unduly preferential coverage of and access to prescribed opioids for pain management without consideration of other pain management services.

(c) Information for enrollees. Every individual or group health insurance carrier shall distribute educational materials to network providers about a pain management access plan under subsection (a) and post information about the pain management access plan on the carrier's publicly accessible website.

SECTION 4. Chapter 27-41 of the General Laws entitled "Health Maintenance Organizations" is hereby amended by adding thereto the following section: 27-41-101. Access to pain management services.

(a) Every individual or group health insurance contract, plan, or policy that provides prescription coverage and that is delivered, issued for delivery, prescribed, or renewed in this state on or after January 1, 2027, shall develop a plan to provide adequate coverage of, and access to, a broad spectrum of pain management services including, but not limited to, nonopioid, nonnarcotic medication for pain management and nonmedication pain management services that serve as alternatives to the prescribing of opioid or narcotic drugs in accordance with guidelines developed by the bureau.

(b) Approval by health insurance commissioner. Every individual or group health insurance carrier shall file a plan required under subsection (a) of this section with the commissioner for approval. In its review, the commissioner shall consider the adequacy of access to a broad spectrum of pain management services under the plan and whether any policies adopted by the carrier may create unduly preferential coverage of and access to prescribed opioids for pain management without consideration of other pain management services.

(c) Information for enrollees. Every individual or group health insurance carrier shall distribute educational materials to network providers about a pain management access plan under subsection (a) and post information about the pain management access plan on the carrier's publicly accessible website.

SECTION 5. This act shall take effect upon passage.