Bill > H1337

This bill requires various healthcare entities in Massachusetts, including the Group Insurance Commission, Medicaid, and private health insurers, to provide comprehensive coverage for opioid use disorder treatments without barriers. Specifically, the bill mandates coverage for opioid antagonists and opioid agonists (medications used to treat opioid addiction) without requiring prior authorization or a prescription, and eliminates deductibles, copayments, and out-of-pocket costs for these medications. The bill ensures that these treatments can be covered both as medical benefits (when administered in a healthcare facility) and as pharmacy benefits (when dispensed by a pharmacist), with reimbursement rates capped at the average in-network pharmacy benefit rate. Healthcare facilities are prohibited from balance billing patients, and the bill requires that the cost of directly dispensed or administered medications be covered through reimbursement mechanisms determined by relevant state agencies. The only exception to the cost-sharing prohibition is if a plan would lose its tax-exempt status under the Internal Revenue Code. By removing financial and administrative barriers, the bill aims to increase access to critical medications for individuals struggling with opioid use disorder.

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https://malegislature.gov/Bills/194/H1337