SB161 Alabama 2025 Session

Summary

Primary Sponsor

Andrew JonesSenator

Republican

Session

2025 Regular Session

Title

Medicaid; establishing coverage parity between opioid and nonopioid pain medications.

Summary

Medicaid must cover FDA-approved nonopioid pain medications on the same terms as opioids on the Medicaid preferred drug list.

What This Bill Does

The bill requires FDA-approved nonopioid pain medications to be covered by Medicaid on the same terms as opioid pain medications on the preferred drug list. The Medicaid Pharmacy and Therapeutics Committee must review nonopioid drugs using the same criteria as opioids, including clinical efficacy, side effects, appropriate usage, cost effectiveness, and related data such as utilization and potential abuse. FDA-approved nonopioid pain drugs must be considered for coverage immediately upon approval, even if they have not yet been reviewed by the committee, and this applies to drugs provided under contracts with integrated care networks. The Medicaid Agency and Committee must adopt an initial preferred drug list within three months after June 18, 2003, and until then Medicaid will use its existing voluntary list and prior authorization.

Who It Affects

• Medicaid recipients who use or may need nonopioid pain medications, who would gain coverage parity with opioid medications on the preferred drug list.
• Medicaid program administrators and healthcare providers (including the Medicaid Agency, the Medicaid Pharmacy and Therapeutics Committee, and integrated care networks' physicians) who must ensure parity, review nonopioids with the same standards, and manage listing and prior authorization.

Key Provisions

• Amends Section 22-6-123 to require FDA-approved nonopioid pain medications to receive the same coverage as opioid pain medications on the Medicaid preferred drug list.
• The Medicaid Pharmacy and Therapeutics Committee must review nonopioids using the same factors as opioids, including clinical efficacy, side effects, appropriate usage, cost effectiveness, DUR data, SUR data, abuse potential, prescribing and dispensing patterns, labeling, and trusted drug information sources.
• Nonopioid drugs must not be disadvantaged in coverage compared to opioids on the preferred drug list.
• The requirement applies immediately upon FDA approval for nonopioids, regardless of prior committee review, and also applies to drugs under contracts with integrated care networks.
• An initial Medicaid preferred drug list must be adopted not later than three months after June 18, 2003; until then, Medicaid continues using its current voluntary list and prior authorization.
• Drugs that currently require prior authorization shall not be reviewed for inclusion on the preferred drug list unless the committee recommends and the commissioner approves changes.
• Medicaid recipients may appeal prior authorization decisions through the Medicaid fair hearing process; physicians may appeal to Medicaid's Medical Directors.

AI-generated summary using openai/gpt-5-nano on Feb 22, 2026. May contain errors — refer to the official bill text for accuracy.

Subjects

Insurance