Bill > H4958

This bill mandates that various insurance plans and government programs in Massachusetts, including those for state employees, Medicaid recipients, and private insurance policies, must cover opioid antagonists and opioid agonists, which are medications used to treat opioid use disorder. These medications, such as buprenorphine and naloxone, will be considered medically necessary and will not require prior authorization or a prescription from a healthcare practitioner for coverage. Furthermore, these treatments will be exempt from deductibles, coinsurance, copayments, and out-of-pocket limits, unless such exemptions would jeopardize a plan's tax-exempt status under the Internal Revenue Code. The bill also ensures that these medications are covered as both a medical benefit when administered at a healthcare facility and as a pharmacy benefit when dispensed by a pharmacist, with provisions to prevent healthcare facilities from balance billing patients and to ensure their costs are covered.

Health and Social Services

Joint Committee on Financial Services (Joint)

https://malegislature.gov/Bills/194/H4958