SB 5916 — Concerning nonopioid drugs for the treatment of pain.

ENGROSSEDS-3534.1 SUBSTITUTE SENATE BILL 5916 State of Washington 69th Legislature 2026 Regular Session By Senate Health & Long-Term Care (originally sponsored by Senators Harris, Chapman, and Saldaña)Saldaña READPrefiled FIRST12/17/25. TIME 01/28/26.

Read first time 01/12/26.

Referred to Committee on Health & Long-Term Care.

reenactingadding anda amendingnew RCWsection 41.05.017;to chapter 41.05 RCW;

A new section is added to chapter 48.4341.05 RCW to read as follows:

(1) A health plan offered to employees and their covered dependents under this chapter issued or renewed on or after January 1, 2027, andmay anynot healthmaintain careprescription benefitdrug managerpractices asthat defineddisadvantage inor RCWdiscourage 48.200.020nonopioid thatdrugs isfor directlythe treatment or indirectlymanagement contractedof pain with therespect healthto plan, shall provide coverage forrelative atto leastany oneopioid nonopioidor legendnarcotic drug for the treatment or management of painpain, withoutincluding: prescription drug utilization management, including prior authorization or step therapy protocols.

(2)(a) ForDesignating thea purposesnonopioid ofdrug thisas section,a "nonopioidnonpreferred drug"drug meansif aany drugopioid or biologicalnarcotic productdrug that is indicateddesignated toas producea analgesiapreferred withoutdrug; acting on the body's opioid receptors and that has been approved by the United States food and drug administration.

or (b) Establishing more restrictive or more extensive prescription drug utilization management practices, including prior authorization or step therapy requirements, for a nonopioid drug that are more restrictive or more extensive than the least restrictive or extensive prescription drug utilization management practice applicable to an opioid or narcotic drug.

p.

1 SB 5916 (2) For the purposes of this section:

(a) "Nonopioid drug" means a drug or biological product that is indicated to produce analgesia without acting on the body's opioid receptors and that has been approved by the United States food and drug administration.

(b) "Prescription drug utilization management" has the same meaning as in RCW 48.43.400.

(c) "Prior authorization" has the same meaning as in RCW 48.43.400.

(d) "Step therapy protocol" has the same meaning as in RCW 48.43.400.

NEW SECTION.

RCWA 41.05.017new andsection 2025is cadded 389to schapter 348.43 andRCW 2025 c 171 s 2 are each reenacted and amended to read as follows:

p.(1) A health plan issued or renewed on or after January 1, 2027, may not maintain prescription drug practices that disadvantage or discourage nonopioid drugs for the treatment or management of pain with respect to coverage relative to any opioid or narcotic drug for the treatment or management of pain, including:

1(a) ESSBDesignating 5916a Eachnonopioid healthdrug planas thata providesnonpreferred medicaldrug insuranceif offeredany underopioid thisor chapter,narcotic includingdrug plansis createddesignated byas insuringa entities,preferred plansdrug; not subject to the provisions of Title 48 RCW, and plans created under RCW 41.05.140, are subject to the provisions of RCW 48.43.500, 70.02.045, 48.43.505 through 48.43.535, 48.43.537, 48.43.545, 48.43.550, 70.02.110, 70.02.900, 48.43.190, 48.43.083, 48.43.0128, 48.43.780, 48.43.435, 48.43.815, 48.200.020 through 48.200.280, 48.200.300 through 48.200.320, 48.43.440, 48.43.845, 48.43.732, section 1 of this act, and chapter 48.49 RCW.

or (b) Establishing more restrictive or more extensive prescription drug utilization management practices, including prior authorization or step therapy requirements, for a nonopioid drug that are more restrictive or more extensive than the least restrictive or extensive prescription drug utilization management practice applicable to an opioid or narcotic drug.

(2) For the purposes of this section, "nonopioid drug" means a drug or biological product that is indicated to produce analgesia without acting on the body's opioid receptors and that has been approved by the United States food and drug administration.

(1) Beginning January 1, 2027, a managed care organization shallmay providenot coveragemaintain forprescription atdrug leastpractices onethat nonopioiddisadvantage legendor drugdiscourage nonopioid drugs for the treatment or management of pain withoutwith prescriptionrespect drugto utilizationcoverage management,relative includingto priorany authorizationopioid or stepnarcotic therapydrug protocols.for the treatment or management of pain, including:

p.

2 SB 5916 (a) Designating a nonopioid drug as a nonpreferred drug if any opioid or narcotic drug is designated as a preferred drug;

or (b) Establishing more restrictive or more extensive prescription drug utilization management practices, including prior authorization or step therapy protocol requirements, for a nonopioid drug that are more restrictive or more extensive than the least restrictive or extensive prescription drug utilization management practice applicable to an opioid or narcotic drug.

(b) "Prior"Prescription authorization"drug utilization management" has the same meaning as in RCW 48.43.400.

(c) "Step"Prior therapyauthorization" protocol" has the same meaning as in RCW 48.43.400.

(d) "Step therapy protocol" has the same meaning as in RCW 48.43.400.

and p.(2) The advantages and disadvantages of the use of nonopioid alternatives.

2 ESSB 5916 (2) The advantages and disadvantages of the use of nonopioid alternatives.

Thep. definitions in this section apply throughout this section and RCW 48.43.410 ((and)), 48.43.420, and section 1 of this act unless the context clearly requires otherwise.

3 SB 5916 The definitions in this section apply throughout this section and RCW 48.43.410 ((and)), 48.43.420, and section 2 of this act unless the context clearly requires otherwise.

(7) "Prior authorization" means a mandatory process that a carrier or prescription drug utilization management entity requires a provider or facility to follow to determine if a service is a benefit and meets the requirements for medical necessity, clinical p.appropriateness, level of care, or effectiveness in relation to the applicable plan.

3p. ESSB 5916 appropriateness, level of care, or effectiveness in relation to the applicable plan.

4 SB 5916 (8) "Step therapy protocol" means a protocol or program that establishes the specific sequence in which prescription drugs for a specified medical condition will be covered by a health carrier.

45 ESSBSB 5916