PIERRE, S.D. — A bill aimed at expanding insurance coverage for nonopioid prescription pain medications failed during its first committee hearing at the South Dakota Capitol.
The House Health and Human Services Committee voted 10–3 to kill House Bill 1085, which supporters said could help reduce reliance on opioids and curb addiction in South Dakota.
The bill’s sponsor, Rep. Brian Mulder (R-Sioux Falls), said pain management is one of the most common reasons people seek medical care, and too often treatment begins and ends with opioids.
“Every patient deserves equitable access to treatment,” Mulder told lawmakers. “But often through that treatment, they’re prescribed opioids that lead to further problems in their lives and even addiction.”
House Bill 1085 would have prohibited health insurers from denying coverage of a nonopioid pain medication in favor of an opioid when a licensed provider prescribes the nonopioid. It would also have limited prior authorization and step-therapy requirements that are more restrictive than opioids and required insurers to place nonopioid drugs on the lowest cost-sharing tier available for opioids.
Dr. Denis Miller of Siouxland Oral and Maxillofacial Surgery testified in support of the bill, citing his experience with Journavx, a nonopioid pain medication approved by the FDA in January 2025.
Miller said he has treated roughly 350 patients with the drug.
“80% of people who would normally require hydrocodone didn’t need the narcotic at all,” Miller said. “The remaining 20% needed about half as much.”
Several organizations also spoke in favor of the bill, including representatives from a recovery program, the South Dakota State Medical Association, the South Dakota Dental Association and the South Dakota Council of Community Behavioral Health.
“I think this could go a long way toward addressing the opioid crisis in South Dakota,” Miller said.
Opposition came primarily from health insurance providers, who warned the bill would increase premiums and set a precedent for coverage mandates.
“Our health plan already covers these drugs,” said Kim Malsam-Rysdon of Avera Health. “The concern is that this bill would require us to place them on the same tier as generics, which would increase overall plan costs.”
Dylan Wheeler of Sanford Health echoed that concern, saying the proposal could raise premiums for small businesses, families and individuals while benefiting pharmaceutical manufacturers of high-cost medications.
Mulder countered that any short-term increase would be minimal — estimating one to two cents per month — and said the long-term savings from preventing addiction would outweigh those costs.
“I’m taking a bigger-picture approach,” Mulder said. “Nonopioid alternatives matter, and we need to get them into patients’ hands.”
Several lawmakers who voted against the bill said they were concerned about lawmakers mandating insurance coverage, calling it a slippery slope that could invite similar requests from pharmaceutical companies in the future.
