Pennsylvania SB 1196: An Act amending the act of June 13, 1967 (P.L.31, No.21), known as the Human Services Code, in public assistance, providing for pain parity in Medicaid and for pain parity in commercial insurance.

Bill Text

PRINTER'S NO. 1440
THE GENERAL ASSEMBLY OF PENNSYLVANIA
SENATE BILL
No. 1196
Session of
2026
INTRODUCED BY TARTAGLIONE, STREET, CAPPELLETTI, SCHWANK, MALONE
AND COLLETT, FEBRUARY 24, 2026
REFERRED TO HEALTH AND HUMAN SERVICES, FEBRUARY 24, 2026
AN ACT
Amending the act of June 13, 1967 (P.L.31, No.21), entitled "An
act to consolidate, editorially revise, and codify the public
welfare laws of the Commonwealth," in public assistance,
providing for pain parity in Medicaid and for pain parity in
commercial insurance.
The General Assembly of the Commonwealth of Pennsylvania
hereby enacts as follows:
Section 1. The act of June 13, 1967 (P.L.31, No.21), known
as the Human Services Code, is amended by adding sections to
read:
Section 459.2. Pain Parity in Medicaid.--(a) In maintaining
the uniform Statewide preferred drug list under section 459.1,
the department may not disadvantage a non-opioid drug approved
by the United States Food and Drug Administration for the
treatment or management of pain with any equivalent opioid or
narcotic drug for the treatment or management of pain on the
uniform Statewide preferred drug list.
(b) The department fails to comply with subsection (a) if
the department:
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(1) designates a non-opioid drug as a nonpreferred drug if
any opioid or narcotic drug is designated as a preferred drug;
or
(2) establishes more restrictive or more extensive
utilization controls, including more restrictive or more
extensive prior authorization or step therapy requirements for a
non-opioid drug than the least restrictive or extensive
utilization controls applicable to any opioid or narcotic drug.
(c) This section applies:
(1) To a non-opioid drug on and after the date on which the
non-opioid drug is approved by the United States Food and Drug
Administration for the treatment or management of pain,
regardless of whether the drug has been reviewed by the
department for inclusion on the uniform Statewide preferred drug
list.
(2) To a drug authorized for use under a contract between
the department and a managed care organization.
Section 459.3. Pain Parity in Commercial Insurance.--(a) An
insurer may not disadvantage a non-opioid drug approved by the
United States Food and Drug Administration for the treatment or
management of pain with respect to coverage or cost sharing,
relative to any opioid or narcotic drug for the treatment or
management of pain on the formulary or preferred drug list.
(b) An insurer fails to comply with subsection (a) if the
insurer:
(1) imposes more restrictive coverage criteria on any non-
opioid drug than the least restrictive coverage criteria imposed
on an opioid or narcotic drug;
(2) establishes more restrictive or more extensive
utilization controls, including more restrictive or more
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extensive prior authorization or step therapy requirements for a
non-opioid drug than the least restrictive or extensive
utilization controls applicable to any opioid or narcotic drug;
or
(3) maintains a formulary or preferred drug list grouped
into tiers for the purposes of determining cost sharing, placing
any non-opioid drug on a tier that requires a cost-sharing
responsibility that exceeds the lowest cost-sharing
responsibility required for any opioid or narcotic drug on the
formulary.
(c) This section applies to a non-opioid drug on and after
the date on which the non-opioid drug is approved by the United
States Food and Drug Administration for the treatment or
management of pain.
Section 2. This act shall take effect in 60 days.
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