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HB 2364

Prohibiting certain health insurers from requiring cost-sharing for nonopioid prescription drugs or providing less favorable coverage for such drug than that for opioid or narcotic prescription drugs for the treatment of pain.

2025-2026 Regular Session

Kansas public insurers must guarantee parity for FDA-approved nonopioid pain meds with opioids, no opioid-first, no stricter coverage or higher cost-sharing for nonopioids.

Died in Senate Committee
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Bill Summary · HB 2364

Summary — HB 2364 (2025)

Status: Introduced Feb. 3, 2025; referred to House Committee on Health and Human Services (introduced version).
Primary purpose: prohibit certain public health insurers from denying or disadvantaging FDA‑approved nonopioid prescription drugs for pain relative to opioid or narcotic prescription drugs.

What the bill would do (main provisions)

  • Applies to "health insurer" defined to include: the Kansas Medicaid program, the State Children's Health Insurance Program (SCHIP), the State Employee Health Benefits Plan, and any managed care organization for those programs/plans.
  • When a prescriber prescribes a nonopioid medication to treat acute pain:
    • The insurer may not deny coverage of that nonopioid in favor of an opioid prescription.
    • The insurer may not require a patient to try an opioid prescription before covering the nonopioid (i.e., bans opioid-first step therapy in that circumstance).
  • In formularies and benefit design the insurer must ensure that any FDA‑approved nonopioid drug for the treatment or management of pain is not disadvantaged or discouraged relative to any opioid/narcotic drug. Examples of impermissible disadvantaging include:
    • Imposing more restrictive coverage criteria on a nonopioid than the least restrictive criteria applied to any opioid.
    • Applying more restrictive or extensive utilization controls (e.g., prior authorization, step therapy) to nonopioids than to opioids.
    • Placing a nonopioid on a higher cost‑sharing tier than the lowest cost‑sharing tier assigned to any opioid on the formulary.
  • The bill does not prevent insurers from preferring one opioid over another opioid, or one nonopioid over another nonopioid.
  • Effective date: the act takes effect upon publication in the statute book (per the introduced Kansas version).

Who is affected

  • Directly: beneficiaries/enrollees of Kansas Medicaid, SCHIP, and the State Employee Health Benefits Plan (and persons covered under managed care contracts).
  • Insurers/plan administrators and managed care organizations administering those public programs — they would need to adjust formulary design, utilization management rules, and cost‑sharing structures to ensure parity for qualifying nonopioid drugs.
  • Prescribers and pharmacists: clearer pathway for nonopioid prescriptions to be covered without mandatory opioid trials.
  • State budget (see fiscal impact below).

Fiscal impact (from Kansas Division of the Budget fiscal note, Feb. 24, 2025)

  • State Employee Health Benefits Program: estimated increase in expenditures of $1,000,000 in FY2026 and $1,085,000 in FY2027, charged to the Health Benefits Administration Clearing Fund (funded by state employee premium revenue). FY2027 figure assumes an 8.5% medical cost increase over FY2026.
  • Kansas Medicaid: Department of Health and Environment indicates the bill aligns with current Medicaid policy for nonopioids and would have no fiscal effect on the agency.
  • Department of Insurance: no fiscal effect indicated.
  • The fiscal effect on the state employee plan reflects increased prescription costs from modified coverage; implementation/administrative costs are not separately identified.

Procedural notes / timeline

  • Introduced in early February 2025 and referred to the House Committee on Health and Human Services. (Fiscal note dated Feb. 24, 2025.)
  • Further committee action and amendments may change scope, applicability, or cost estimates.

Key considerations

  • The bill focuses on parity for FDA‑approved nonopioid drugs used for pain management and limits insurer practices that could steer patients toward opioid therapy.
  • It targets public programs (Medicaid, SCHIP, state employee plan) rather than private commercial markets (unless those private plans participate as managed care contractors).
  • Implementation would require plan formulary reviews and potential changes to utilization management and tiering structures to avoid prohibited disadvantaging.

Compiled from official sources — confirm details with the bill’s official record.

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