RI 2026 S3022A: Insurance - Accident and Sickness Insurance Policies

Plain-English Summary

This bill requires health insurance companies and Medicaid programs in Rhode Island to provide coverage for non-opioid and non-narcotic pain management treatments. Insurers must develop a plan, approved by the Department of Health, ensuring patients have access to these alternative pain treatments. Additionally, the bill prohibits insurers from making it harder for patients to get approval for non-opioid pain medications than it is to get approval for opioid drugs. Insurers must also educate healthcare providers about these options and post their pain management plans on their websites.

For younger readers

Sometimes when people get hurt or have surgery, doctors give them strong medicine called opioids to stop the pain. But opioids can be dangerous if people take too much. This bill makes a rule for health insurance companies, which are the companies that help pay for doctor visits and medicine. It says they must also help pay for safer ways to stop pain, like different medicines or therapies. It also says insurance companies cannot make it harder for doctors to give out the safer medicines than the dangerous ones.

Who & Where It Applies

Impacted groups

Health insurance carriersPatients requiring pain managementMedical providers and prescribersMedicaid recipientsDepartment of Health officials

Impacted communities

All

Constitutional & Fiscal Check

None Likely. The bill regulates health insurance providers and Medicaid contracts, which falls well within the state's traditional police powers to regulate insurance and protect public health. It does not infringe upon free speech, due process, or protection from unreasonable searches and seizures.

Estimated cost

Amount unknown

Estimated revenue

None

Bill Analysis

Both viewpoints

For Progressives

Combats the opioid epidemic by ensuring patients have equitable access to safer, non-addictive pain management alternatives, protecting community welfare and public health.
Includes Medicaid (medical assistance programs) in the mandate, ensuring that low-income and disadvantaged individuals have the same access to non-opioid pain treatments as those with private insurance.
Regulates corporate health insurance carriers by preventing them from using cost-saving loopholes, like strict step therapy or prior authorization, to deny patients access to non-opioid medications.
Does not mandate free coverage for these alternative treatments, meaning out-of-pocket costs like copays or deductibles could still burden low-income patients.
The provisions do not apply to insurance policies until January 1, 2027, delaying necessary systemic reform and relief for patients currently struggling with pain management and addiction risks.
Relies heavily on the Department of Health to approve the plans without explicitly defining strict, progressive minimum standards for what constitutes adequate coverage for holistic nonmedication pain management services.

For Conservatives

Addresses the opioid crisis, which has devastated traditional families and communities, by encouraging safer pain management options without banning opioids outright or limiting a doctor's ability to prescribe them when necessary.
Maintains the ability of private insurance companies to design their own pain management plans for approval, rather than imposing a single, strict government-run healthcare model.
Reduces potential long-term dependency on government assistance programs by preventing opioid addiction, which often leads to disability, job loss, and reliance on state welfare.
Imposes new government mandates and regulations on private health insurance companies, restricting corporate freedom and dictating how they manage their prescription coverage plans.
Strips insurance carriers of their ability to freely use utilization reviews (like step therapy) for non-opioid drugs, potentially driving up the cost of healthcare premiums for everyone.
Requires insurers to create and submit new plans to the Department of Health for approval, increasing bureaucratic red tape and administrative costs for businesses.

Votes

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Full Bill Text

2 versions

Changes to existing Rhode Island law · 113 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 department of health. (b)(1) Approval by department of health. Every individual or group health insurance carrier shall file a plan required under subsection (a) of this section with the director for approval. In its review, the director 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.

(2) No 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 apply any utilization review, including without limitation, prior authorization or step therapy protocols, for clinically appropriate nonopioid prescription drugs approved by the United States Food and Drug Administration for the treatment or management of moderate to severe pain, that is more restrictive or extensive than the least restrictive or extensive utilization review applicable to any clinically appropriate opioid or narcotic drug.

(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 department of health. (b)(1) Approval by department of health. Every individual or group health insurance carrier shall file a plan required under subsection (a) of this section with the director for approval. In its review, the director 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.

(2) No 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 apply any utilization review, including without limitation, prior authorization or step therapy protocols, for clinically appropriate nonopioid prescription drugs approved by the United States Food and Drug Administration for the treatment or management of moderate to severe pain, that is more restrictive or extensive than the least restrictive or extensive utilization review applicable to any clinically appropriate opioid or narcotic drug.

(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 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 department of health. (b)(1) Approval by department of health. Every individual or group health insurance carrier shall file a plan required under subsection (a) of this section with the director for approval. In its review, the director 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.

(2) No 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 apply any utilization review, including without limitation, prior authorization or step therapy protocols, for clinically appropriate nonopioid prescription drugs approved by the United States Food and Drug Administration for the treatment or management of moderate to severe pain, that is more restrictive or extensive than the least restrictive or extensive utilization review applicable to any clinically appropriate opioid or narcotic drug.

(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 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 department of health. (b)(1) Approval by department of health. Every individual or group health insurance carrier shall file a plan required under subsection (a) of this section with the director for approval. In its review, the director 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.

(2) No 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 apply any utilization review, including without limitation, prior authorization or step therapy protocols, for clinically appropriate nonopioid prescription drugs approved by the United States Food and Drug Administration for the treatment or management of moderate to severe pain, that is more restrictive or extensive than the least restrictive or extensive utilization review applicable to any clinically appropriate opioid or narcotic drug.

(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 5. Chapter 40-21 of the General Laws entitled "Medical Assistance — Prescription Drugs" is hereby amended by adding thereto the following section: 40-21-4. Access to nonopioid pain treatment.

(a) The Rhode Island medical assistance program, as defined under chapter 8 of this title, and any contract between the Rhode Island medical assistance program and a managed care organization, shall not apply any utilization review, including without limitation prior authorization or step therapy protocols, for clinically appropriate nonopioid prescription drugs approved by the United States Food and Drug Administration for the treatment or management of moderate to severe pain, that is more restrictive or extensive than the least restrictive or extensive utilization review applicable to any clinically appropriate opioid or narcotic drug.

(b) The Rhode Island medical assistance program shall require, through amending current and future medical assistance managed care contracts, that managed care organizations meet the provisions of this section.

(c) This section applies to all policies, contracts, and plans executed, delivered, issued for delivery, continued or renewed in this state on or after January 1, 2027.

SECTION 6. This act shall take effect upon passage.