CALIFORNIA LEGISLATURE 20172018 REGULAR SESSION Assembly Bill No. 2384Introduced by Assembly Member ArambulaFebruary 14, 2018 An act to add Section 1367.207 to the Health and Safety Code, and to add Section 10123.204 to the Insurance Code, relating to medication-assisted treatment. LEGISLATIVE COUNSEL'S DIGESTAB 2384, as introduced, Arambula. Medication-assisted treatment.Existing law, the Knox-Keene Health Care Service Plan Act of 1975 (Knox-Keene), provides for the licensure and regulation of health care service plans by the Department of Managed Health Care and makes a willful violation of the act a crime. Existing law provides for the regulation of health insurers by the Department of Insurance. Existing law establishes the Medi-Cal program, which is administered by the State Department of Health Care Services, under which qualified low-income individuals receive health care services. The Medi-Cal program is, in part, governed and funded by federal Medicaid program provisions.Existing law requires the State Department of Health Care Services to license narcotic treatment programs to use narcotic replacement therapy in the treatment of addicted persons. Existing law specifies certain drugs, including methadone and buprenorphine, that are authorized for use in narcotic replacement therapy and medication-assisted treatment by licensed narcotic treatment programs. Existing law establishes the Drug Medi-Cal Treatment Program, under which the department is authorized to enter into contracts with each county for the provision of various alcohol and drug treatment services, including substance use disorder services, narcotic treatment program services, naltrexone services, and outpatient drug-free services, to Medi-Cal beneficiaries.This bill would require a drug formulary maintained by a health care service plan, including a Medi-Cal managed plan, or health insurer to include, at a minimum, specified prescription drugs for the medication-assisted treatment, as defined, of substance abuse disorders. The bill would provide that medication-assisted treatment is presumed to be medically necessary, and is not subject to specified requirements of a health care service plan or policy of health insurance, including prior authorization and an annual or lifetime dollar limit. Because a willful violation of the bills requirements relative to health care service plans would be a crime, the bill would impose a state-mandated local program.The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement.This bill would provide that no reimbursement is required by this act for a specified reason.Digest Key Vote: MAJORITY Appropriation: NO Fiscal Committee: YES Local Program: YES Bill TextThe people of the State of California do enact as follows:SECTION 1. Section 1367.207 is added to the Health and Safety Code, to read:1367.207. (a) A health care service plan that provides prescription drug benefits and maintains one or more drug formularies shall include, at a minimum, the following medication-assisted treatment prescription drugs for substance abuse disorders:(1) Buprenorphine.(2) Methadone.(3) Naloxone.(4) Extended-release injectable naltrexone.(5) A combination of buprenorphine and naloxone.(6) New formulations and medications as they are approved by the United States Food and Drug Administration (FDA) for the treatment of substance abuse disorders.(b) Medication-assisted treatment provided pursuant to this section is presumed to be medically necessary and is not subject to the following:(1) Prior authorization.(2) An annual or lifetime dollar limit.(3) A limitation to a predesignated facility, a specific number of visits, days of coverage, scope or duration of treatment, or other similar limitations.(4) Financial requirements different than those for other illnesses covered under the health care service plan.(5) Step therapy, fail first policies, or other similar drug utilization strategies or policies for patients that may conflict with a prescribed course of treatment from a licensed health care professional.(c) The requirements of this section shall not be subject to an insureds prior success or failure with the medication-assisted treatment services provided.(d) For purposes of this section, the following definitions apply:(1) Medication-assisted treatment means the use of medications, commonly in combination with counseling and behavioral therapy, to provide a comprehensive approach to the treatment of substance abuse disorders. Medication-assisted treatment includes, but is not limited to, pharmacologic and behavioral therapies.(2) Pharmacologic therapy means a prescribed course of treatment that may include methadone, buprenorphine, naltrexone, or other FDA-approved or evidence-based medications for the treatment of substance abuse disorders.(3) Behavioral therapy means an individual, family, or group therapy designed to help a patient engage in the treatment process, modify a patients attitude and behaviors related to substance abuse disorders, and increase healthy life skills.(4) Medically necessary means a service that is reasonable and necessary to protect life, prevent significant illness or significant disability, or to alleviate severe pain, as determined by a treating licensed health care professional in consultation with the patient.(5) Financial requirements means a deductible, copayment, coinsurance, or out-of-pocket maximum.(e) For purposes of this section, health care service plan includes Medi-Cal managed care plans that contract with the State Department of Health Care Services pursuant to Chapter 7 (commencing with Section 14000) and Chapter 8 (commencing with Section 14200) of Part 3 of Division 9 of the Welfare and Institutions Code.SEC. 2. Section 10123.204 is added to the Insurance Code, to read:10123.204. (a) A health insurer that provides prescription drug benefits and maintains one or more drug formularies shall include, at a minimum, the following medication-assisted treatment prescription drugs for substance abuse disorders:(1) Buprenorphine.(2) Methadone.(3) Naloxone.(4) Extended-release injectable naltrexone.(5) A combination of buprenorphine and naloxone.(6) New formulations and medications as they are approved by the United States Food and Drug Administration (FDA) for the treatment of substance abuse disorders.(b) Medication-assisted treatment provided pursuant to this section is presumed to be medically necessary and is not subject to the following:(1) Prior authorization.(2) An annual or lifetime dollar limit.(3) A limitation to a predesignated facility, a specific number of visits, days of coverage, scope or duration of treatment, or other similar limitations.(4) Financial requirements different than those for other illnesses covered under the policy of health insurance.(5) Step therapy, fail first policies, or other similar drug utilization strategies or policies for patients that may conflict with a prescribed course of treatment from a licensed health care professional.(c) The requirements of this section shall not be subject to an enrollees prior success or failure with the medication-assisted treatment services provided.(d) For purposes of this section, the following definitions apply:(1) Medication-assisted treatment means the use of medications, commonly in combination with counseling and behavioral therapy, to provide a comprehensive approach to the treatment of substance abuse disorders. Medication-assisted treatment includes, but is not limited to, pharmacologic and behavioral therapies.(2) Pharmacologic therapy means a prescribed course of treatment that may include methadone, buprenorphine, naltrexone, or other FDA-approved or evidence-based medications for the treatment of substance abuse disorders.(3) Behavioral therapy means an individual, family, or group therapy designed to help a patient engage in the treatment process, modify a patients attitude and behaviors related to substance abuse disorders, and increase healthy life skills.(4) Medically necessary means a service that is reasonable and necessary to protect life, prevent significant illness or significant disability, or to alleviate severe pain, as determined by a treating licensed health care professional in consultation with the patient.(5) Financial requirements means a deductible, copayment, coinsurance, or out-of-pocket maximum.SEC. 3. No reimbursement is required by this act pursuant to Section 6 of Article XIIIB of the California Constitution because the only costs that may be incurred by a local agency or school district will be incurred because this act creates a new crime or infraction, eliminates a crime or infraction, or changes the penalty for a crime or infraction, within the meaning of Section 17556 of the Government Code, or changes the definition of a crime within the meaning of Section 6 of Article XIIIB of the California Constitution.
CALIFORNIA LEGISLATURE 20172018 REGULAR SESSION Assembly Bill No. 2384Introduced by Assembly Member ArambulaFebruary 14, 2018 An act to add Section 1367.207 to the Health and Safety Code, and to add Section 10123.204 to the Insurance Code, relating to medication-assisted treatment. LEGISLATIVE COUNSEL'S DIGESTAB 2384, as introduced, Arambula. Medication-assisted treatment.Existing law, the Knox-Keene Health Care Service Plan Act of 1975 (Knox-Keene), provides for the licensure and regulation of health care service plans by the Department of Managed Health Care and makes a willful violation of the act a crime. Existing law provides for the regulation of health insurers by the Department of Insurance. Existing law establishes the Medi-Cal program, which is administered by the State Department of Health Care Services, under which qualified low-income individuals receive health care services. The Medi-Cal program is, in part, governed and funded by federal Medicaid program provisions.Existing law requires the State Department of Health Care Services to license narcotic treatment programs to use narcotic replacement therapy in the treatment of addicted persons. Existing law specifies certain drugs, including methadone and buprenorphine, that are authorized for use in narcotic replacement therapy and medication-assisted treatment by licensed narcotic treatment programs. Existing law establishes the Drug Medi-Cal Treatment Program, under which the department is authorized to enter into contracts with each county for the provision of various alcohol and drug treatment services, including substance use disorder services, narcotic treatment program services, naltrexone services, and outpatient drug-free services, to Medi-Cal beneficiaries.This bill would require a drug formulary maintained by a health care service plan, including a Medi-Cal managed plan, or health insurer to include, at a minimum, specified prescription drugs for the medication-assisted treatment, as defined, of substance abuse disorders. The bill would provide that medication-assisted treatment is presumed to be medically necessary, and is not subject to specified requirements of a health care service plan or policy of health insurance, including prior authorization and an annual or lifetime dollar limit. Because a willful violation of the bills requirements relative to health care service plans would be a crime, the bill would impose a state-mandated local program.The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement.This bill would provide that no reimbursement is required by this act for a specified reason.Digest Key Vote: MAJORITY Appropriation: NO Fiscal Committee: YES Local Program: YES
CALIFORNIA LEGISLATURE 20172018 REGULAR SESSION
Assembly Bill No. 2384
Introduced by Assembly Member ArambulaFebruary 14, 2018
Introduced by Assembly Member Arambula
February 14, 2018
An act to add Section 1367.207 to the Health and Safety Code, and to add Section 10123.204 to the Insurance Code, relating to medication-assisted treatment.
LEGISLATIVE COUNSEL'S DIGEST
## LEGISLATIVE COUNSEL'S DIGEST
AB 2384, as introduced, Arambula. Medication-assisted treatment.
Existing law, the Knox-Keene Health Care Service Plan Act of 1975 (Knox-Keene), provides for the licensure and regulation of health care service plans by the Department of Managed Health Care and makes a willful violation of the act a crime. Existing law provides for the regulation of health insurers by the Department of Insurance. Existing law establishes the Medi-Cal program, which is administered by the State Department of Health Care Services, under which qualified low-income individuals receive health care services. The Medi-Cal program is, in part, governed and funded by federal Medicaid program provisions.Existing law requires the State Department of Health Care Services to license narcotic treatment programs to use narcotic replacement therapy in the treatment of addicted persons. Existing law specifies certain drugs, including methadone and buprenorphine, that are authorized for use in narcotic replacement therapy and medication-assisted treatment by licensed narcotic treatment programs. Existing law establishes the Drug Medi-Cal Treatment Program, under which the department is authorized to enter into contracts with each county for the provision of various alcohol and drug treatment services, including substance use disorder services, narcotic treatment program services, naltrexone services, and outpatient drug-free services, to Medi-Cal beneficiaries.This bill would require a drug formulary maintained by a health care service plan, including a Medi-Cal managed plan, or health insurer to include, at a minimum, specified prescription drugs for the medication-assisted treatment, as defined, of substance abuse disorders. The bill would provide that medication-assisted treatment is presumed to be medically necessary, and is not subject to specified requirements of a health care service plan or policy of health insurance, including prior authorization and an annual or lifetime dollar limit. Because a willful violation of the bills requirements relative to health care service plans would be a crime, the bill would impose a state-mandated local program.The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement.This bill would provide that no reimbursement is required by this act for a specified reason.
Existing law, the Knox-Keene Health Care Service Plan Act of 1975 (Knox-Keene), provides for the licensure and regulation of health care service plans by the Department of Managed Health Care and makes a willful violation of the act a crime. Existing law provides for the regulation of health insurers by the Department of Insurance. Existing law establishes the Medi-Cal program, which is administered by the State Department of Health Care Services, under which qualified low-income individuals receive health care services. The Medi-Cal program is, in part, governed and funded by federal Medicaid program provisions.
Existing law requires the State Department of Health Care Services to license narcotic treatment programs to use narcotic replacement therapy in the treatment of addicted persons. Existing law specifies certain drugs, including methadone and buprenorphine, that are authorized for use in narcotic replacement therapy and medication-assisted treatment by licensed narcotic treatment programs. Existing law establishes the Drug Medi-Cal Treatment Program, under which the department is authorized to enter into contracts with each county for the provision of various alcohol and drug treatment services, including substance use disorder services, narcotic treatment program services, naltrexone services, and outpatient drug-free services, to Medi-Cal beneficiaries.
This bill would require a drug formulary maintained by a health care service plan, including a Medi-Cal managed plan, or health insurer to include, at a minimum, specified prescription drugs for the medication-assisted treatment, as defined, of substance abuse disorders. The bill would provide that medication-assisted treatment is presumed to be medically necessary, and is not subject to specified requirements of a health care service plan or policy of health insurance, including prior authorization and an annual or lifetime dollar limit. Because a willful violation of the bills requirements relative to health care service plans would be a crime, the bill would impose a state-mandated local program.
The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement.
This bill would provide that no reimbursement is required by this act for a specified reason.
## Digest Key
## Bill Text
The people of the State of California do enact as follows:SECTION 1. Section 1367.207 is added to the Health and Safety Code, to read:1367.207. (a) A health care service plan that provides prescription drug benefits and maintains one or more drug formularies shall include, at a minimum, the following medication-assisted treatment prescription drugs for substance abuse disorders:(1) Buprenorphine.(2) Methadone.(3) Naloxone.(4) Extended-release injectable naltrexone.(5) A combination of buprenorphine and naloxone.(6) New formulations and medications as they are approved by the United States Food and Drug Administration (FDA) for the treatment of substance abuse disorders.(b) Medication-assisted treatment provided pursuant to this section is presumed to be medically necessary and is not subject to the following:(1) Prior authorization.(2) An annual or lifetime dollar limit.(3) A limitation to a predesignated facility, a specific number of visits, days of coverage, scope or duration of treatment, or other similar limitations.(4) Financial requirements different than those for other illnesses covered under the health care service plan.(5) Step therapy, fail first policies, or other similar drug utilization strategies or policies for patients that may conflict with a prescribed course of treatment from a licensed health care professional.(c) The requirements of this section shall not be subject to an insureds prior success or failure with the medication-assisted treatment services provided.(d) For purposes of this section, the following definitions apply:(1) Medication-assisted treatment means the use of medications, commonly in combination with counseling and behavioral therapy, to provide a comprehensive approach to the treatment of substance abuse disorders. Medication-assisted treatment includes, but is not limited to, pharmacologic and behavioral therapies.(2) Pharmacologic therapy means a prescribed course of treatment that may include methadone, buprenorphine, naltrexone, or other FDA-approved or evidence-based medications for the treatment of substance abuse disorders.(3) Behavioral therapy means an individual, family, or group therapy designed to help a patient engage in the treatment process, modify a patients attitude and behaviors related to substance abuse disorders, and increase healthy life skills.(4) Medically necessary means a service that is reasonable and necessary to protect life, prevent significant illness or significant disability, or to alleviate severe pain, as determined by a treating licensed health care professional in consultation with the patient.(5) Financial requirements means a deductible, copayment, coinsurance, or out-of-pocket maximum.(e) For purposes of this section, health care service plan includes Medi-Cal managed care plans that contract with the State Department of Health Care Services pursuant to Chapter 7 (commencing with Section 14000) and Chapter 8 (commencing with Section 14200) of Part 3 of Division 9 of the Welfare and Institutions Code.SEC. 2. Section 10123.204 is added to the Insurance Code, to read:10123.204. (a) A health insurer that provides prescription drug benefits and maintains one or more drug formularies shall include, at a minimum, the following medication-assisted treatment prescription drugs for substance abuse disorders:(1) Buprenorphine.(2) Methadone.(3) Naloxone.(4) Extended-release injectable naltrexone.(5) A combination of buprenorphine and naloxone.(6) New formulations and medications as they are approved by the United States Food and Drug Administration (FDA) for the treatment of substance abuse disorders.(b) Medication-assisted treatment provided pursuant to this section is presumed to be medically necessary and is not subject to the following:(1) Prior authorization.(2) An annual or lifetime dollar limit.(3) A limitation to a predesignated facility, a specific number of visits, days of coverage, scope or duration of treatment, or other similar limitations.(4) Financial requirements different than those for other illnesses covered under the policy of health insurance.(5) Step therapy, fail first policies, or other similar drug utilization strategies or policies for patients that may conflict with a prescribed course of treatment from a licensed health care professional.(c) The requirements of this section shall not be subject to an enrollees prior success or failure with the medication-assisted treatment services provided.(d) For purposes of this section, the following definitions apply:(1) Medication-assisted treatment means the use of medications, commonly in combination with counseling and behavioral therapy, to provide a comprehensive approach to the treatment of substance abuse disorders. Medication-assisted treatment includes, but is not limited to, pharmacologic and behavioral therapies.(2) Pharmacologic therapy means a prescribed course of treatment that may include methadone, buprenorphine, naltrexone, or other FDA-approved or evidence-based medications for the treatment of substance abuse disorders.(3) Behavioral therapy means an individual, family, or group therapy designed to help a patient engage in the treatment process, modify a patients attitude and behaviors related to substance abuse disorders, and increase healthy life skills.(4) Medically necessary means a service that is reasonable and necessary to protect life, prevent significant illness or significant disability, or to alleviate severe pain, as determined by a treating licensed health care professional in consultation with the patient.(5) Financial requirements means a deductible, copayment, coinsurance, or out-of-pocket maximum.SEC. 3. No reimbursement is required by this act pursuant to Section 6 of Article XIIIB of the California Constitution because the only costs that may be incurred by a local agency or school district will be incurred because this act creates a new crime or infraction, eliminates a crime or infraction, or changes the penalty for a crime or infraction, within the meaning of Section 17556 of the Government Code, or changes the definition of a crime within the meaning of Section 6 of Article XIIIB of the California Constitution.
The people of the State of California do enact as follows:
## The people of the State of California do enact as follows:
SECTION 1. Section 1367.207 is added to the Health and Safety Code, to read:1367.207. (a) A health care service plan that provides prescription drug benefits and maintains one or more drug formularies shall include, at a minimum, the following medication-assisted treatment prescription drugs for substance abuse disorders:(1) Buprenorphine.(2) Methadone.(3) Naloxone.(4) Extended-release injectable naltrexone.(5) A combination of buprenorphine and naloxone.(6) New formulations and medications as they are approved by the United States Food and Drug Administration (FDA) for the treatment of substance abuse disorders.(b) Medication-assisted treatment provided pursuant to this section is presumed to be medically necessary and is not subject to the following:(1) Prior authorization.(2) An annual or lifetime dollar limit.(3) A limitation to a predesignated facility, a specific number of visits, days of coverage, scope or duration of treatment, or other similar limitations.(4) Financial requirements different than those for other illnesses covered under the health care service plan.(5) Step therapy, fail first policies, or other similar drug utilization strategies or policies for patients that may conflict with a prescribed course of treatment from a licensed health care professional.(c) The requirements of this section shall not be subject to an insureds prior success or failure with the medication-assisted treatment services provided.(d) For purposes of this section, the following definitions apply:(1) Medication-assisted treatment means the use of medications, commonly in combination with counseling and behavioral therapy, to provide a comprehensive approach to the treatment of substance abuse disorders. Medication-assisted treatment includes, but is not limited to, pharmacologic and behavioral therapies.(2) Pharmacologic therapy means a prescribed course of treatment that may include methadone, buprenorphine, naltrexone, or other FDA-approved or evidence-based medications for the treatment of substance abuse disorders.(3) Behavioral therapy means an individual, family, or group therapy designed to help a patient engage in the treatment process, modify a patients attitude and behaviors related to substance abuse disorders, and increase healthy life skills.(4) Medically necessary means a service that is reasonable and necessary to protect life, prevent significant illness or significant disability, or to alleviate severe pain, as determined by a treating licensed health care professional in consultation with the patient.(5) Financial requirements means a deductible, copayment, coinsurance, or out-of-pocket maximum.(e) For purposes of this section, health care service plan includes Medi-Cal managed care plans that contract with the State Department of Health Care Services pursuant to Chapter 7 (commencing with Section 14000) and Chapter 8 (commencing with Section 14200) of Part 3 of Division 9 of the Welfare and Institutions Code.
SECTION 1. Section 1367.207 is added to the Health and Safety Code, to read:
### SECTION 1.
1367.207. (a) A health care service plan that provides prescription drug benefits and maintains one or more drug formularies shall include, at a minimum, the following medication-assisted treatment prescription drugs for substance abuse disorders:(1) Buprenorphine.(2) Methadone.(3) Naloxone.(4) Extended-release injectable naltrexone.(5) A combination of buprenorphine and naloxone.(6) New formulations and medications as they are approved by the United States Food and Drug Administration (FDA) for the treatment of substance abuse disorders.(b) Medication-assisted treatment provided pursuant to this section is presumed to be medically necessary and is not subject to the following:(1) Prior authorization.(2) An annual or lifetime dollar limit.(3) A limitation to a predesignated facility, a specific number of visits, days of coverage, scope or duration of treatment, or other similar limitations.(4) Financial requirements different than those for other illnesses covered under the health care service plan.(5) Step therapy, fail first policies, or other similar drug utilization strategies or policies for patients that may conflict with a prescribed course of treatment from a licensed health care professional.(c) The requirements of this section shall not be subject to an insureds prior success or failure with the medication-assisted treatment services provided.(d) For purposes of this section, the following definitions apply:(1) Medication-assisted treatment means the use of medications, commonly in combination with counseling and behavioral therapy, to provide a comprehensive approach to the treatment of substance abuse disorders. Medication-assisted treatment includes, but is not limited to, pharmacologic and behavioral therapies.(2) Pharmacologic therapy means a prescribed course of treatment that may include methadone, buprenorphine, naltrexone, or other FDA-approved or evidence-based medications for the treatment of substance abuse disorders.(3) Behavioral therapy means an individual, family, or group therapy designed to help a patient engage in the treatment process, modify a patients attitude and behaviors related to substance abuse disorders, and increase healthy life skills.(4) Medically necessary means a service that is reasonable and necessary to protect life, prevent significant illness or significant disability, or to alleviate severe pain, as determined by a treating licensed health care professional in consultation with the patient.(5) Financial requirements means a deductible, copayment, coinsurance, or out-of-pocket maximum.(e) For purposes of this section, health care service plan includes Medi-Cal managed care plans that contract with the State Department of Health Care Services pursuant to Chapter 7 (commencing with Section 14000) and Chapter 8 (commencing with Section 14200) of Part 3 of Division 9 of the Welfare and Institutions Code.
1367.207. (a) A health care service plan that provides prescription drug benefits and maintains one or more drug formularies shall include, at a minimum, the following medication-assisted treatment prescription drugs for substance abuse disorders:(1) Buprenorphine.(2) Methadone.(3) Naloxone.(4) Extended-release injectable naltrexone.(5) A combination of buprenorphine and naloxone.(6) New formulations and medications as they are approved by the United States Food and Drug Administration (FDA) for the treatment of substance abuse disorders.(b) Medication-assisted treatment provided pursuant to this section is presumed to be medically necessary and is not subject to the following:(1) Prior authorization.(2) An annual or lifetime dollar limit.(3) A limitation to a predesignated facility, a specific number of visits, days of coverage, scope or duration of treatment, or other similar limitations.(4) Financial requirements different than those for other illnesses covered under the health care service plan.(5) Step therapy, fail first policies, or other similar drug utilization strategies or policies for patients that may conflict with a prescribed course of treatment from a licensed health care professional.(c) The requirements of this section shall not be subject to an insureds prior success or failure with the medication-assisted treatment services provided.(d) For purposes of this section, the following definitions apply:(1) Medication-assisted treatment means the use of medications, commonly in combination with counseling and behavioral therapy, to provide a comprehensive approach to the treatment of substance abuse disorders. Medication-assisted treatment includes, but is not limited to, pharmacologic and behavioral therapies.(2) Pharmacologic therapy means a prescribed course of treatment that may include methadone, buprenorphine, naltrexone, or other FDA-approved or evidence-based medications for the treatment of substance abuse disorders.(3) Behavioral therapy means an individual, family, or group therapy designed to help a patient engage in the treatment process, modify a patients attitude and behaviors related to substance abuse disorders, and increase healthy life skills.(4) Medically necessary means a service that is reasonable and necessary to protect life, prevent significant illness or significant disability, or to alleviate severe pain, as determined by a treating licensed health care professional in consultation with the patient.(5) Financial requirements means a deductible, copayment, coinsurance, or out-of-pocket maximum.(e) For purposes of this section, health care service plan includes Medi-Cal managed care plans that contract with the State Department of Health Care Services pursuant to Chapter 7 (commencing with Section 14000) and Chapter 8 (commencing with Section 14200) of Part 3 of Division 9 of the Welfare and Institutions Code.
1367.207. (a) A health care service plan that provides prescription drug benefits and maintains one or more drug formularies shall include, at a minimum, the following medication-assisted treatment prescription drugs for substance abuse disorders:(1) Buprenorphine.(2) Methadone.(3) Naloxone.(4) Extended-release injectable naltrexone.(5) A combination of buprenorphine and naloxone.(6) New formulations and medications as they are approved by the United States Food and Drug Administration (FDA) for the treatment of substance abuse disorders.(b) Medication-assisted treatment provided pursuant to this section is presumed to be medically necessary and is not subject to the following:(1) Prior authorization.(2) An annual or lifetime dollar limit.(3) A limitation to a predesignated facility, a specific number of visits, days of coverage, scope or duration of treatment, or other similar limitations.(4) Financial requirements different than those for other illnesses covered under the health care service plan.(5) Step therapy, fail first policies, or other similar drug utilization strategies or policies for patients that may conflict with a prescribed course of treatment from a licensed health care professional.(c) The requirements of this section shall not be subject to an insureds prior success or failure with the medication-assisted treatment services provided.(d) For purposes of this section, the following definitions apply:(1) Medication-assisted treatment means the use of medications, commonly in combination with counseling and behavioral therapy, to provide a comprehensive approach to the treatment of substance abuse disorders. Medication-assisted treatment includes, but is not limited to, pharmacologic and behavioral therapies.(2) Pharmacologic therapy means a prescribed course of treatment that may include methadone, buprenorphine, naltrexone, or other FDA-approved or evidence-based medications for the treatment of substance abuse disorders.(3) Behavioral therapy means an individual, family, or group therapy designed to help a patient engage in the treatment process, modify a patients attitude and behaviors related to substance abuse disorders, and increase healthy life skills.(4) Medically necessary means a service that is reasonable and necessary to protect life, prevent significant illness or significant disability, or to alleviate severe pain, as determined by a treating licensed health care professional in consultation with the patient.(5) Financial requirements means a deductible, copayment, coinsurance, or out-of-pocket maximum.(e) For purposes of this section, health care service plan includes Medi-Cal managed care plans that contract with the State Department of Health Care Services pursuant to Chapter 7 (commencing with Section 14000) and Chapter 8 (commencing with Section 14200) of Part 3 of Division 9 of the Welfare and Institutions Code.
1367.207. (a) A health care service plan that provides prescription drug benefits and maintains one or more drug formularies shall include, at a minimum, the following medication-assisted treatment prescription drugs for substance abuse disorders:
(1) Buprenorphine.
(2) Methadone.
(3) Naloxone.
(4) Extended-release injectable naltrexone.
(5) A combination of buprenorphine and naloxone.
(6) New formulations and medications as they are approved by the United States Food and Drug Administration (FDA) for the treatment of substance abuse disorders.
(b) Medication-assisted treatment provided pursuant to this section is presumed to be medically necessary and is not subject to the following:
(1) Prior authorization.
(2) An annual or lifetime dollar limit.
(3) A limitation to a predesignated facility, a specific number of visits, days of coverage, scope or duration of treatment, or other similar limitations.
(4) Financial requirements different than those for other illnesses covered under the health care service plan.
(5) Step therapy, fail first policies, or other similar drug utilization strategies or policies for patients that may conflict with a prescribed course of treatment from a licensed health care professional.
(c) The requirements of this section shall not be subject to an insureds prior success or failure with the medication-assisted treatment services provided.
(d) For purposes of this section, the following definitions apply:
(1) Medication-assisted treatment means the use of medications, commonly in combination with counseling and behavioral therapy, to provide a comprehensive approach to the treatment of substance abuse disorders. Medication-assisted treatment includes, but is not limited to, pharmacologic and behavioral therapies.
(2) Pharmacologic therapy means a prescribed course of treatment that may include methadone, buprenorphine, naltrexone, or other FDA-approved or evidence-based medications for the treatment of substance abuse disorders.
(3) Behavioral therapy means an individual, family, or group therapy designed to help a patient engage in the treatment process, modify a patients attitude and behaviors related to substance abuse disorders, and increase healthy life skills.
(4) Medically necessary means a service that is reasonable and necessary to protect life, prevent significant illness or significant disability, or to alleviate severe pain, as determined by a treating licensed health care professional in consultation with the patient.
(5) Financial requirements means a deductible, copayment, coinsurance, or out-of-pocket maximum.
(e) For purposes of this section, health care service plan includes Medi-Cal managed care plans that contract with the State Department of Health Care Services pursuant to Chapter 7 (commencing with Section 14000) and Chapter 8 (commencing with Section 14200) of Part 3 of Division 9 of the Welfare and Institutions Code.
SEC. 2. Section 10123.204 is added to the Insurance Code, to read:10123.204. (a) A health insurer that provides prescription drug benefits and maintains one or more drug formularies shall include, at a minimum, the following medication-assisted treatment prescription drugs for substance abuse disorders:(1) Buprenorphine.(2) Methadone.(3) Naloxone.(4) Extended-release injectable naltrexone.(5) A combination of buprenorphine and naloxone.(6) New formulations and medications as they are approved by the United States Food and Drug Administration (FDA) for the treatment of substance abuse disorders.(b) Medication-assisted treatment provided pursuant to this section is presumed to be medically necessary and is not subject to the following:(1) Prior authorization.(2) An annual or lifetime dollar limit.(3) A limitation to a predesignated facility, a specific number of visits, days of coverage, scope or duration of treatment, or other similar limitations.(4) Financial requirements different than those for other illnesses covered under the policy of health insurance.(5) Step therapy, fail first policies, or other similar drug utilization strategies or policies for patients that may conflict with a prescribed course of treatment from a licensed health care professional.(c) The requirements of this section shall not be subject to an enrollees prior success or failure with the medication-assisted treatment services provided.(d) For purposes of this section, the following definitions apply:(1) Medication-assisted treatment means the use of medications, commonly in combination with counseling and behavioral therapy, to provide a comprehensive approach to the treatment of substance abuse disorders. Medication-assisted treatment includes, but is not limited to, pharmacologic and behavioral therapies.(2) Pharmacologic therapy means a prescribed course of treatment that may include methadone, buprenorphine, naltrexone, or other FDA-approved or evidence-based medications for the treatment of substance abuse disorders.(3) Behavioral therapy means an individual, family, or group therapy designed to help a patient engage in the treatment process, modify a patients attitude and behaviors related to substance abuse disorders, and increase healthy life skills.(4) Medically necessary means a service that is reasonable and necessary to protect life, prevent significant illness or significant disability, or to alleviate severe pain, as determined by a treating licensed health care professional in consultation with the patient.(5) Financial requirements means a deductible, copayment, coinsurance, or out-of-pocket maximum.
SEC. 2. Section 10123.204 is added to the Insurance Code, to read:
### SEC. 2.
10123.204. (a) A health insurer that provides prescription drug benefits and maintains one or more drug formularies shall include, at a minimum, the following medication-assisted treatment prescription drugs for substance abuse disorders:(1) Buprenorphine.(2) Methadone.(3) Naloxone.(4) Extended-release injectable naltrexone.(5) A combination of buprenorphine and naloxone.(6) New formulations and medications as they are approved by the United States Food and Drug Administration (FDA) for the treatment of substance abuse disorders.(b) Medication-assisted treatment provided pursuant to this section is presumed to be medically necessary and is not subject to the following:(1) Prior authorization.(2) An annual or lifetime dollar limit.(3) A limitation to a predesignated facility, a specific number of visits, days of coverage, scope or duration of treatment, or other similar limitations.(4) Financial requirements different than those for other illnesses covered under the policy of health insurance.(5) Step therapy, fail first policies, or other similar drug utilization strategies or policies for patients that may conflict with a prescribed course of treatment from a licensed health care professional.(c) The requirements of this section shall not be subject to an enrollees prior success or failure with the medication-assisted treatment services provided.(d) For purposes of this section, the following definitions apply:(1) Medication-assisted treatment means the use of medications, commonly in combination with counseling and behavioral therapy, to provide a comprehensive approach to the treatment of substance abuse disorders. Medication-assisted treatment includes, but is not limited to, pharmacologic and behavioral therapies.(2) Pharmacologic therapy means a prescribed course of treatment that may include methadone, buprenorphine, naltrexone, or other FDA-approved or evidence-based medications for the treatment of substance abuse disorders.(3) Behavioral therapy means an individual, family, or group therapy designed to help a patient engage in the treatment process, modify a patients attitude and behaviors related to substance abuse disorders, and increase healthy life skills.(4) Medically necessary means a service that is reasonable and necessary to protect life, prevent significant illness or significant disability, or to alleviate severe pain, as determined by a treating licensed health care professional in consultation with the patient.(5) Financial requirements means a deductible, copayment, coinsurance, or out-of-pocket maximum.
10123.204. (a) A health insurer that provides prescription drug benefits and maintains one or more drug formularies shall include, at a minimum, the following medication-assisted treatment prescription drugs for substance abuse disorders:(1) Buprenorphine.(2) Methadone.(3) Naloxone.(4) Extended-release injectable naltrexone.(5) A combination of buprenorphine and naloxone.(6) New formulations and medications as they are approved by the United States Food and Drug Administration (FDA) for the treatment of substance abuse disorders.(b) Medication-assisted treatment provided pursuant to this section is presumed to be medically necessary and is not subject to the following:(1) Prior authorization.(2) An annual or lifetime dollar limit.(3) A limitation to a predesignated facility, a specific number of visits, days of coverage, scope or duration of treatment, or other similar limitations.(4) Financial requirements different than those for other illnesses covered under the policy of health insurance.(5) Step therapy, fail first policies, or other similar drug utilization strategies or policies for patients that may conflict with a prescribed course of treatment from a licensed health care professional.(c) The requirements of this section shall not be subject to an enrollees prior success or failure with the medication-assisted treatment services provided.(d) For purposes of this section, the following definitions apply:(1) Medication-assisted treatment means the use of medications, commonly in combination with counseling and behavioral therapy, to provide a comprehensive approach to the treatment of substance abuse disorders. Medication-assisted treatment includes, but is not limited to, pharmacologic and behavioral therapies.(2) Pharmacologic therapy means a prescribed course of treatment that may include methadone, buprenorphine, naltrexone, or other FDA-approved or evidence-based medications for the treatment of substance abuse disorders.(3) Behavioral therapy means an individual, family, or group therapy designed to help a patient engage in the treatment process, modify a patients attitude and behaviors related to substance abuse disorders, and increase healthy life skills.(4) Medically necessary means a service that is reasonable and necessary to protect life, prevent significant illness or significant disability, or to alleviate severe pain, as determined by a treating licensed health care professional in consultation with the patient.(5) Financial requirements means a deductible, copayment, coinsurance, or out-of-pocket maximum.
10123.204. (a) A health insurer that provides prescription drug benefits and maintains one or more drug formularies shall include, at a minimum, the following medication-assisted treatment prescription drugs for substance abuse disorders:(1) Buprenorphine.(2) Methadone.(3) Naloxone.(4) Extended-release injectable naltrexone.(5) A combination of buprenorphine and naloxone.(6) New formulations and medications as they are approved by the United States Food and Drug Administration (FDA) for the treatment of substance abuse disorders.(b) Medication-assisted treatment provided pursuant to this section is presumed to be medically necessary and is not subject to the following:(1) Prior authorization.(2) An annual or lifetime dollar limit.(3) A limitation to a predesignated facility, a specific number of visits, days of coverage, scope or duration of treatment, or other similar limitations.(4) Financial requirements different than those for other illnesses covered under the policy of health insurance.(5) Step therapy, fail first policies, or other similar drug utilization strategies or policies for patients that may conflict with a prescribed course of treatment from a licensed health care professional.(c) The requirements of this section shall not be subject to an enrollees prior success or failure with the medication-assisted treatment services provided.(d) For purposes of this section, the following definitions apply:(1) Medication-assisted treatment means the use of medications, commonly in combination with counseling and behavioral therapy, to provide a comprehensive approach to the treatment of substance abuse disorders. Medication-assisted treatment includes, but is not limited to, pharmacologic and behavioral therapies.(2) Pharmacologic therapy means a prescribed course of treatment that may include methadone, buprenorphine, naltrexone, or other FDA-approved or evidence-based medications for the treatment of substance abuse disorders.(3) Behavioral therapy means an individual, family, or group therapy designed to help a patient engage in the treatment process, modify a patients attitude and behaviors related to substance abuse disorders, and increase healthy life skills.(4) Medically necessary means a service that is reasonable and necessary to protect life, prevent significant illness or significant disability, or to alleviate severe pain, as determined by a treating licensed health care professional in consultation with the patient.(5) Financial requirements means a deductible, copayment, coinsurance, or out-of-pocket maximum.
10123.204. (a) A health insurer that provides prescription drug benefits and maintains one or more drug formularies shall include, at a minimum, the following medication-assisted treatment prescription drugs for substance abuse disorders:
(1) Buprenorphine.
(2) Methadone.
(3) Naloxone.
(4) Extended-release injectable naltrexone.
(5) A combination of buprenorphine and naloxone.
(6) New formulations and medications as they are approved by the United States Food and Drug Administration (FDA) for the treatment of substance abuse disorders.
(b) Medication-assisted treatment provided pursuant to this section is presumed to be medically necessary and is not subject to the following:
(1) Prior authorization.
(2) An annual or lifetime dollar limit.
(3) A limitation to a predesignated facility, a specific number of visits, days of coverage, scope or duration of treatment, or other similar limitations.
(4) Financial requirements different than those for other illnesses covered under the policy of health insurance.
(5) Step therapy, fail first policies, or other similar drug utilization strategies or policies for patients that may conflict with a prescribed course of treatment from a licensed health care professional.
(c) The requirements of this section shall not be subject to an enrollees prior success or failure with the medication-assisted treatment services provided.
(d) For purposes of this section, the following definitions apply:
(1) Medication-assisted treatment means the use of medications, commonly in combination with counseling and behavioral therapy, to provide a comprehensive approach to the treatment of substance abuse disorders. Medication-assisted treatment includes, but is not limited to, pharmacologic and behavioral therapies.
(2) Pharmacologic therapy means a prescribed course of treatment that may include methadone, buprenorphine, naltrexone, or other FDA-approved or evidence-based medications for the treatment of substance abuse disorders.
(3) Behavioral therapy means an individual, family, or group therapy designed to help a patient engage in the treatment process, modify a patients attitude and behaviors related to substance abuse disorders, and increase healthy life skills.
(4) Medically necessary means a service that is reasonable and necessary to protect life, prevent significant illness or significant disability, or to alleviate severe pain, as determined by a treating licensed health care professional in consultation with the patient.
(5) Financial requirements means a deductible, copayment, coinsurance, or out-of-pocket maximum.
SEC. 3. No reimbursement is required by this act pursuant to Section 6 of Article XIIIB of the California Constitution because the only costs that may be incurred by a local agency or school district will be incurred because this act creates a new crime or infraction, eliminates a crime or infraction, or changes the penalty for a crime or infraction, within the meaning of Section 17556 of the Government Code, or changes the definition of a crime within the meaning of Section 6 of Article XIIIB of the California Constitution.
SEC. 3. No reimbursement is required by this act pursuant to Section 6 of Article XIIIB of the California Constitution because the only costs that may be incurred by a local agency or school district will be incurred because this act creates a new crime or infraction, eliminates a crime or infraction, or changes the penalty for a crime or infraction, within the meaning of Section 17556 of the Government Code, or changes the definition of a crime within the meaning of Section 6 of Article XIIIB of the California Constitution.
SEC. 3. No reimbursement is required by this act pursuant to Section 6 of Article XIIIB of the California Constitution because the only costs that may be incurred by a local agency or school district will be incurred because this act creates a new crime or infraction, eliminates a crime or infraction, or changes the penalty for a crime or infraction, within the meaning of Section 17556 of the Government Code, or changes the definition of a crime within the meaning of Section 6 of Article XIIIB of the California Constitution.
### SEC. 3.