New York Assembly Bill A01921

New York 2025-2026 Regular Session

• Introduced: 1/14/25
• Refer: 1/14/25
• Refer: 1/7/26

Caption

Provides outpatient insurance coverage for non-pharmacological treatments and non-opioid drugs for chronic pain.

Summary

This bill would require certain New York health insurance policies and contracts that cover pain management services to also cover outpatient non-opioid treatment for chronic pain. The required coverage includes complementary and integrative treatments, as well as FDA-approved non-opioid drugs for acute or chronic pain. The bill applies to individual, group, blanket, and certain nonprofit health plans, and it defines chronic pain as pain lasting or recurring for more than three months and acute pain as short-term pain. The bill also bars insurers from imposing more restrictive financial requirements or treatment limits on non-opioid pain treatments than they apply to most medical benefits generally or to opioid-based pain treatments. It specifically prohibits practices that would disadvantage non-opioid drugs, such as placing them on a non-preferred tier when opioid drugs are preferred, or subjecting them to stricter prior authorization, step therapy, or other utilization controls. The measure would take effect on the first day of January after enactment and would apply to policies and contracts issued, renewed, modified, altered, or amended on or after that date.

Impact

The bill would amend sections 3216, 3221, and 4303 of the New York Insurance Law to create a coverage mandate for non-opioid pain treatment across major categories of health insurance. It would require insurers and health service corporations to treat non-opioid pain therapies comparably to opioid-based therapies in terms of cost-sharing, prior authorization, step therapy, network access, and other utilization management tools. The practical effect would be to expand insured access to alternative pain management options and limit insurer discretion to favor opioids over non-opioid therapies in benefit design.

Sentiment

Based on the bill text and available context, the measure appears to be framed as a patient-access and opioid-sparing policy, with an overall supportive orientation toward expanding coverage for safer pain management options. No committee transcript or vote record was provided, so there is no documented recorded opposition or amendment debate in the supplied materials. The bill’s structure suggests a policy consensus goal of improving access to non-opioid treatments while preventing discriminatory insurance coverage practices.

Contention

The main potential point of contention is the bill’s restriction on insurer benefit design, especially its limits on prior authorization, step therapy, preferred drug tiering, and other utilization controls. Insurers and managed care plans may view these provisions as reducing flexibility to manage costs and medical necessity, while supporters would likely argue that comparable coverage is needed to prevent non-opioid therapies from being disfavored relative to opioids. Another possible issue is the breadth of the mandate, which covers both complementary/integrative treatments and FDA-approved non-opioid drugs, potentially affecting a wide range of providers and plan structures.