NC H1048

Requires health benefit plans that cover abuse-deterrent opioid analgesics to impose the same prior authorization requirements for abuse-deterrent and non-abuse-deterrent opioid products, and prohibits plans from requiring patients to use non-abuse-deterrent opioids before covering abuse-deterrent alternatives.

Establishes step therapy protocol standards requiring clinical review criteria to be based on independent, multidisciplinary clinical practice guidelines developed by experts with no affiliation to health benefit plans or utilization review organizations.

Creates a process for patients and prescribers to request step therapy override determinations, which must be granted if the required drug is contraindicated, expected to be ineffective, previously failed, not in the patient's best interest, or if the patient is stable on an alternative drug.

Allows health plans to continue requiring generic equivalents prior to branded drugs and does not restrict healthcare providers from prescribing medically appropriate drugs.

Becomes effective October 1, 2016, for insurance contracts issued, renewed, or amended on or after that date.