HOUSE DOCKET, NO. 3714        FILED ON: 1/20/2023

HOUSE  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  No. 1142

The Commonwealth of Massachusetts

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PRESENTED BY:

Jon Santiago

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To the Honorable Senate and House of Representatives of the Commonwealth of Massachusetts in General
Court assembled:

The undersigned legislators and/or citizens respectfully petition for the adoption of the accompanying bill:

An Act to prohibit cost sharing for opioid antagonists.

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PETITION OF:

HOUSE DOCKET, NO. 3714        FILED ON: 1/20/2023

HOUSE  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  No. 1142

The Commonwealth of Massachusetts

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In the One Hundred and Ninety-Third General Court
(2023-2024)

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An Act to prohibit cost sharing for opioid antagonists.

Be it enacted by the Senate and House of Representatives in General Court assembled, and by the authority of the same, as follows:
 

SECTION 1.  Said chapter 32A is hereby further amended by adding the following section:-

Section 33. (a) For the purpose of this section, the following words shall have the following meaning:

''Opioid antagonists,'' naloxone or any other drug approved by the federal Food and Drug Administration as a competitive narcotic antagonist used in the reversal of overdoses caused by opioids.

(b) Any coverage offered by the commission to an active or retired employee of the commonwealth insured under the group insurance commission shall provide coverage for opioid antagonists. Opioid antagonists shall be covered with no patient cost-sharing; provided, however, that cost-sharing shall be allowed if the applicable plan is governed by the Federal Internal Revenue Code and would lose its tax-exempt status as a result of the prohibition on cost-sharing for this service.

(c) A prescription from a health care practitioner shall not be required for coverage of opioid antagonists in accordance with the statewide standing order issued under section 19B of chapter 94C.

SECTION 2. Chapter 118E of the General Laws is hereby amended by inserting after section 10Q the following section:-

Section 10R. (a) For the purpose of this section, the following words shall have the following meaning:

''Opioid antagonists,'' naloxone or any other drug approved by the federal Food and Drug Administration as a competitive narcotic antagonist used in the reversal of overdoses caused by opioids.

(b) The division and its contracted health insurers, health plans, health maintenance organizations, behavioral health management firms and third-party administrators under contract to a Medicaid managed care organization or primary care clinician plan shall provide coverage for opioid antagonists. Opioid antagonists shall be covered with no patient cost-sharing; provided, however, that cost-sharing shall be allowed if the applicable plan is governed by the Federal Internal Revenue Code and would lose its tax-exempt status as a result of the prohibition on cost-sharing for this service.

(c) A prescription from a health care practitioner shall not be required for coverage of opioid antagonists in accordance with the statewide standing order issued under section 19B of chapter 94C.

SECTION 3. Said chapter 175 is hereby further amended by inserting after section 47TT, the following section:-

Section 47UU. (a) For the purpose of this section, the following words shall have the following meaning:

''Opioid antagonists,'' naloxone or any other drug approved by the federal Food and Drug Administration as a competitive narcotic antagonist used in the reversal of overdoses caused by opioids.

(b) The following shall provide coverage for opioid antagonists: (i) any policy of accident and sickness insurance, as described in section 108, which provides hospital expense and surgical expense insurance and which is delivered, issued or subsequently renewed by agreement between the insurer and policyholder in the commonwealth; (ii) any blanket or general policy of insurance described in subdivision (A), (C) or (D) of section 110 which provides hospital expense and surgical expense insurance and which is delivered, issued or subsequently renewed by agreement between the insurer and the policyholder in or outside of the commonwealth; and (iii) any employees’ health and welfare fund which provides hospital expense and surgical expense benefits and which is delivered, issued to or renewed for any person or group of persons in the commonwealth. Opioid antagonists shall be covered with no patient cost-sharing; provided, however, that cost-sharing shall be allowed if the applicable plan is governed by the Federal Internal Revenue Code and would lose its tax-exempt status as a result of the prohibition on cost-sharing for this service.

(c) A prescription from a health care practitioner shall not be required for coverage of opioid antagonists in accordance with the statewide standing order issued under section 19B of chapter 94C.

SECTION 4. Said chapter 176A is hereby further amended by inserting after section 8UU the following section:-

Section 8VV. (a) For the purpose of this section, the following words shall have the following meaning:

''Opioid antagonists,'' naloxone or any other drug approved by the federal Food and Drug Administration as a competitive narcotic antagonist used in the reversal of overdoses caused by opioids.

(b) A contract between a subscriber and the corporation under an individual or group hospital service plan which is delivered, issued or renewed within the commonwealth shall provide coverage for opioid antagonists. Opioid antagonists shall be covered with no patient cost-sharing; provided, however, that cost-sharing shall be allowed if the applicable plan is governed by the Federal Internal Revenue Code and would lose its tax-exempt status as a result of the prohibition on cost-sharing for this service.

(c) A prescription from a health care practitioner shall not be required for coverage of opioid antagonists in accordance with the statewide standing order issued under section 19B of chapter 94C.

SECTION 5. Said chapter 176B is hereby further amended by inserting after section 4UU the following section:-

Section 4VV. (a) For the purpose of this section, the following words shall have the following meaning:

''Opioid antagonists,'' naloxone or any other drug approved by the federal Food and Drug Administration as a competitive narcotic antagonist used in the reversal of overdoses caused by opioids.

(b) A subscription certificate under an individual or group medical service agreement delivered, issued or renewed within the commonwealth shall provide coverage for opioid antagonists. Opioid antagonists shall be covered with no patient cost-sharing; provided, however, that cost-sharing shall be allowed if the applicable plan is governed by the Federal Internal Revenue Code and would lose its tax-exempt status as a result of the prohibition on cost-sharing for this service.

(c) A prescription from a health care practitioner shall not be required for coverage of opioid antagonists in accordance with the statewide standing order issued under section 19B of chapter 94C.

SECTION 6. Said chapter 176G is hereby further amended by inserting after section 4MM the following section:-

Section 4NN. (a) For the purpose of this section, the following words shall have the following meaning:

''Opioid antagonists,'' naloxone or any other drug approved by the federal Food and Drug Administration as a competitive narcotic antagonist used in the reversal of overdoses caused by opioids.

(b) An individual or group health maintenance contract that is issued or renewed within or without the commonwealth shall provide coverage for opioid antagonists. Opioid antagonists shall be covered with no patient cost-sharing; provided, however, that cost-sharing shall be allowed if the applicable plan is governed by the Federal Internal Revenue Code and would lose its tax-exempt status as a result of the prohibition on cost-sharing for this service.

(c) A prescription from a health care practitioner shall not be required for coverage of opioid antagonists in accordance with the statewide standing order issued under section 19B of chapter 94C.