HB 2060 — 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.

PRINTER'S NO.   2644

                     THE GENERAL ASSEMBLY OF PENNSYLVANIA



                         HOUSE BILL
                         No. 2060
                                               Session of
                                                 2025

     INTRODUCED BY BURGOS, HILL-EVANS, K.HARRIS, RIVERA, SANCHEZ AND
        BOYD, NOVEMBER 19, 2025

     REFERRED TO COMMITTEE ON HUMAN SERVICES, DECEMBER 3, 2025


                                    AN ACT
 1   Amending the act of June 13, 1967 (P.L.31, No.21), entitled "An
 2      act to consolidate, editorially revise, and codify the public
 3      welfare laws of the Commonwealth," in public assistance,
 4      providing for pain parity in Medicaid and for pain parity in
 5      commercial insurance.
 6      The General Assembly of the Commonwealth of Pennsylvania
 7   hereby enacts as follows:
 8      Section 1.    The act of June 13, 1967 (P.L.31, No.21), known
 9   as the Human Services Code, is amended by adding sections to
10   read:
11      Section 459.2.    Pain Parity in Medicaid.--(a)     In
12   establishing and maintaining the uniform Statewide preferred
13   drug list under section 459.1, the department shall ensure that
14   no non-opioid drug approved by the United States Food and Drug
15   Administration for the treatment or management of pain shall be
16   disadvantaged or discouraged with respect to coverage relative
17   to any opioid or narcotic drug for the treatment or management
18   of pain on the uniform Statewide preferred drug list, where
19   impermissible disadvantaging or discouragement includes, without
 1   limitation, designating any non-opioid drug as a nonpreferred
 2   drug if any opioid or narcotic drug is designated as a preferred
 3   drug or establishing more restrictive or more extensive
 4   utilization controls, including, but not limited to, more
 5   restrictive or more extensive prior authorization or step
 6   therapy requirements for a non-opioid drug than the least
 7   restrictive or extensive utilization controls applicable to any
 8   opioid or narcotic drug.
 9      (b)   This section shall apply to a non-opioid drug
10   immediately upon its approval by the United States Food and Drug
11   Administration for the treatment or management of pain,
12   regardless of whether the drug has been reviewed by the
13   department for inclusion on the uniform Statewide preferred drug
14   list. This section shall apply to drugs being provided under a
15   contract between the department and any managed care
16   organization.
17      Section 459.3.   Pain Parity in Commercial Insurance.--(a)    In
18   establishing and maintaining a formulary or preferred drug list,
19   a commercial insurer shall ensure that no non-opioid drug
20   approved by the United States Food and Drug Administration for
21   the treatment or management of pain shall be disadvantaged or
22   discouraged, with respect to coverage or cost sharing, relative
23   to any opioid or narcotic drug for the treatment or management
24   of pain on the formulary or preferred drug list, where
25   impermissible disadvantaging or discouragement includes, without
26   limitation:
27      (1)   imposing more restrictive coverage criteria on any non-
28   opioid drug than the least restrictive coverage criteria imposed
29   on an opioid or narcotic drug;
30      (2)   establishing more restrictive or more extensive

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 1   utilization controls, including, but not limited to, more
 2   restrictive or more extensive prior authorization or step
 3   therapy requirements for a non-opioid drug than the least
 4   restrictive or extensive utilization controls applicable to any
 5   opioid or narcotic drug; or
 6      (3)   if an insurer maintains a formulary or preferred drug
 7   list grouped into tiers for the purposes of determining cost
 8   sharing, placing any non-opioid drug on a tier that requires a
 9   cost-sharing responsibility that exceeds the lowest cost-sharing
10   responsibility required for any opioid or narcotic drug on the
11   formulary.
12      (b)   This section shall apply to a non-opioid drug
13   immediately upon its approval by the United States Food and Drug
14   Administration for the treatment or management of pain.
15      Section 2.   This act shall take effect in 60 days.




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