Delaware · Through 2026-10-01 (85 Del. Laws, c. 550)

18 Del. C. § 3571X: Medications for mental health disorders and substance use disorders [Effective Jan. 1, 2028].

(a) [Repealed.]
(b) If group health insurance coverage provides prescription medication benefits for the treatment of a mental health disorder or substance use disorder, as defined by § 3578 of this title, a health insurer must place at least 1 formulation of each FDA-approved medication to treat 1 or more substance use disorders, regardless of whether the prescription drug is formulary, nonformulary, or excluded, on the lowest tier of the drug formulary developed and maintained by the carrier, including each of the following:
(1) Buprenorphine.
(2) Naltrexone.
(3) Naloxone.
(4) A product containing both buprenorphine and naloxone.
(5) Disulfiram.
(6) Acamprosate.
(c) A health insurer that provides coverage for prescription drugs must cover the fees associated with the administration or dispensing of methadone dispensed at an “opioid treatment program” as defined under 42 C.F.R. § 8.2.
(d) A health insurer shall provide benefits under this section as follows:
(1) Not impose a prior authorization requirement.
(2) Must authorize coverage of prescription medicine without imposing a step therapy requirement for at least 1 formulation of each FDA-approved medication to treat 1 or more substance use disorders that is on each tier of the drug formulary developed and maintained by the health insurer. A health insurer may impose a step therapy requirement for a prescription medication only to require use of a therapeutically equivalent generic drug that is rated as therapeutically equivalent (AB-rated) by the United States Food and Drug Administration and has the same active ingredient, dosage form, and strength as the prescribed medication. Notwithstanding any step therapy requirement permitted under this subsection, a health insurer shall authorize coverage of the prescribed dosage form or formulation of the prescribed medication when the prescribed formulation is reasonably expected to provide clinical benefit for the covered person.

Where this section sits in the code

Title 18. Insurance Code
Part I. Insurance
Chapter 35. Group and Blanket Health Insurance
Subchapter III. Provisions Applicable to Group and Blanket Health Insurance

(a) [Repealed.]

(b) If group health insurance coverage provides prescription medication benefits for the treatment of a mental health disorder or substance use disorder, as defined by § 3578 of this title, a health insurer must place at least 1 formulation of each FDA-approved medication to treat 1 or more substance use disorders, regardless of whether the prescription drug is formulary, nonformulary, or excluded, on the lowest tier of the drug formulary developed and maintained by the carrier, including each of the following:

(1) Buprenorphine.

(2) Naltrexone.

(3) Naloxone.

(4) A product containing both buprenorphine and naloxone.

(5) Disulfiram.

(6) Acamprosate.

(c) A health insurer that provides coverage for prescription drugs must cover the fees associated with the administration or dispensing of methadone dispensed at an “opioid treatment program” as defined under 42 C.F.R. § 8.2.

(d) A health insurer shall provide benefits under this section as follows:

(1) Not impose a prior authorization requirement.

(2) Must authorize coverage of prescription medicine without imposing a step therapy requirement for at least 1 formulation of each FDA-approved medication to treat 1 or more substance use disorders that is on each tier of the drug formulary developed and maintained by the health insurer. A health insurer may impose a step therapy requirement for a prescription medication only to require use of a therapeutically equivalent generic drug that is rated as therapeutically equivalent (AB-rated) by the United States Food and Drug Administration and has the same active ingredient, dosage form, and strength as the prescribed medication. Notwithstanding any step therapy requirement permitted under this subsection, a health insurer shall authorize coverage of the prescribed dosage form or formulation of the prescribed medication when the prescribed formulation is reasonably expected to provide clinical benefit for the covered person.

Collected 2026-10-21T05:49:49Z. Source file · JSON

Browse this collection