An Act relative to opioid use disorder treatment and rehabilitation coverage
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Progress
Where this bill stands in the legislative process.
- Introduced
- Passed House
- Passed Senate
- To Governor
- Became Law
Overview
This bill aims to expand access to treatment and rehabilitation for opioid use disorder by ensuring that health insurance plans, including those offered by the Commonwealth and private insurers, cover opioid antagonists and agonists, including partial agonists. It removes barriers to care by eliminating prior authorization requirements and cost-sharing for these medications, and establishes reimbursement rates for healthcare facilities and pharmacies.
Key provisions
- Requires health insurance plans to cover opioid antagonists and agonists used in treating opioid use disorder.
- Eliminates prior authorization requirements for these medications.
- Prohibits cost-sharing (deductibles, coinsurance, copays) for these medications.
- Establishes reimbursement rates for substance use treatment facilities and pharmacies.
- Extends coverage to Commonwealth employees, Medicaid recipients, and individuals with private health insurance.
- Specifies that coverage should be provided as a medical benefit and a pharmacy benefit.
- Requires that reimbursement rates for healthcare facilities not exceed in-network pharmacy benefit rates.
- Addresses balance billing practices to protect patients.
Who is affected
- Individuals with opioid use disorder
- Healthcare providers (including substance use treatment facilities and pharmacists)
- Health insurance companies (private and Commonwealth)
Bill text
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Sponsors
Official sponsors from legislative records.
3 on record
Primary sponsor
Joint Committee on Financial Services
Cosponsors
Andres X. Vargas
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