| Old | New | Differences | |
|---|---|---|---|
| 1 | - | ||
| 1 | + | Amended IN Senate August 23, 2018 Amended IN Senate July 03, 2018 Amended IN Senate June 14, 2018 Amended IN Assembly May 25, 2018 Amended IN Assembly May 01, 2018 Amended IN Assembly April 18, 2018 CALIFORNIA LEGISLATURE 20172018 REGULAR SESSION Assembly Bill No. 2384Introduced by Assembly Member ArambulaFebruary 14, 2018 An act to add and repeal Section 1367.207 of the Health and Safety Code, and to add and repeal Section 10123.204 of the Insurance Code, relating to medication-assisted treatment. LEGISLATIVE COUNSEL'S DIGESTAB 2384, as amended, Arambula. Medication-assisted treatment.Existing law, the Knox-Keene Health Care Service Plan Act of 1975, 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, until January 1, 2024, would require a health insurer or a health care service plan, not including a Medi-Cal managed care plan, to cover, at a minimum, at least one version of each specified medication-assisted treatment treatment, relapse prevention, and overdose reversal prescription drug approved by the United States Food and Drug Administration for opioid use disorder. The bill would provide that at least one version of each medication-assisted treatment, as identified by a health care service plan or health insurer, relapse prevention, and overdose reversal prescription drug 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, as specified. The bill would specify that its provisions would apply to an FDA-approved drug for use in medication-assisted treatment for opioid use disorder disorder, relapse prevention, or overdose reversal that an enrollee or insured is being prescribed as of January 1, 2019, or, for a new enrollee or insured, that he or she is being prescribed at the time of enrollment. Because a willful violation of those provisions by a health care service plan 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 shall cover, at a minimum, at least one version of each of the following medication-assisted treatment treatment, relapse prevention, and overdose reversal prescription drugs approved by the United States Food and Drug Administration (FDA) for opioid use disorder, regardless of whether a drug is self-administered or administered by a health care provider:(1) Buprenorphine.(2) Methadone.(3) Naltrexone.(4) A combination of buprenorphine and naloxone.(5) Naloxone in at least one form of administration approved for community use.(b) Each of the medications listed in subdivision (a) may be substituted for an equivalent drug that is approved by the FDA for medication-assisted treatment treatment, relapse prevention, or overdose reversal, and serves the same medical function as the drug being substituted. substituted, if the substitution is consistent with clinical guidelines and peer-reviewed scientific and medical literature.(c) Only At least one version of each of the five medication-assisted treatment treatment, relapse prevention, and overdose reversal prescription drugs listed in subdivision (a) and identified by a health care service plan is not shall not be subject to the following:(1) Prior authorization.(2) An annual or lifetime dollar limit, if federal restrictions on those limits are amended, revised, or repealed.(3) A requirement that the enrollee receives coverage at an outpatient facility that exceeds allowable time and distance standards for network adequacy, 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. policies.(d) The requirements of this section shall not be subject to an enrollees prior success or failure with the medication-assisted treatment services provided. treatment.(e) This section applies to an FDA-approved drug for use in medication-assisted treatment for opioid use disorder disorder, relapse prevention, or overdose reversal that an enrollee is being prescribed as of January 1, 2019, or, for a new enrollee, that the new enrollee is being prescribed at the time of enrollment.(f) 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 opioid use disorder. Medication-assisted treatment includes, but is not limited to, pharmacologic therapies with or without 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 opioid use disorder.(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 opioid use disorder, and increase healthy life skills.(4) Financial requirements means a deductible, copayment, coinsurance, or out-of-pocket maximum.(g) For purposes of this section, health care service plan does not include 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. Code, or Medi-Cal managed care plans that provide services pursuant to Chapter 3 (commencing with Section 15850) of Part 3.3 of Division 9 of the Welfare and Institutions Code.(h) This section does not restrict or impair the application of any other provision of this part.(i) This section shall remain in effect only until January 1, 2024, and as of that date is repealed.SEC. 2. Section 10123.204 is added to the Insurance Code, to read:10123.204. (a) A health insurer that provides prescription drug benefits shall cover, at a minimum, at least one version of each of the following medication-assisted treatment treatment, relapse prevention, and overdose reversal prescription drugs approved by the United States Food and Drug Administration (FDA) for opioid use disorder, regardless of whether a drug is self-administered or administered by a health care provider:(1) Buprenorphine.(2) Methadone.(3) Naltrexone.(4) A combination of buprenorphine and naloxone.(5) Naloxone in at least one form of administration approved for community use.(b) Each of the medications listed in subdivision (a) may be substituted for an equivalent drug that is approved by the FDA for medication-assisted treatment treatment, relapse prevention, or overdose reversal, and serves the same medical function as the drug being substituted. substituted, if the substitution is consistent with clinical guidelines and peer-reviewed scientific and medical literature.(c) Only At least one version of each of the five medication-assisted treatment treatment, relapse prevention, and overdose reversal prescription drugs listed in subdivision (a) and identified by a health insurer is not shall not be subject to the following:(1) Prior authorization.(2) An annual or lifetime dollar limit, if federal restrictions on those limits are amended, revised, or repealed.(3) A requirement that the insured receives coverage at an outpatient facility that exceeds allowable time and distance standards for network adequacy, 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. policies.(d) The requirements of this section shall not be subject to an insureds prior success or failure with the medication-assisted treatment services provided. treatment.(e) This section applies to an FDA-approved drug for use in medication-assisted treatment for opioid use disorder disorder, relapse prevention, or overdose reversal that an insured is being prescribed as of January 1, 2019, or, for a new insured, that the new insured is being prescribed at the time of enrollment.(f) 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 opioid use disorder. Medication-assisted treatment includes, but is not limited to, pharmacologic therapies with or without 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 opioid use disorder.(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 opioid use disorder, and increase healthy life skills.(4) Financial requirements means a deductible, copayment, coinsurance, or out-of-pocket maximum.(g) This section does not restrict or impair the application of any other provision of this part.(h) This section shall remain in effect only until January 1, 2024, and as of that date is repealed.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. | |
| 2 | 2 | ||
| 3 | - | ||
| 3 | + | Amended IN Senate August 23, 2018 Amended IN Senate July 03, 2018 Amended IN Senate June 14, 2018 Amended IN Assembly May 25, 2018 Amended IN Assembly May 01, 2018 Amended IN Assembly April 18, 2018 CALIFORNIA LEGISLATURE 20172018 REGULAR SESSION Assembly Bill No. 2384Introduced by Assembly Member ArambulaFebruary 14, 2018 An act to add and repeal Section 1367.207 of the Health and Safety Code, and to add and repeal Section 10123.204 of the Insurance Code, relating to medication-assisted treatment. LEGISLATIVE COUNSEL'S DIGESTAB 2384, as amended, Arambula. Medication-assisted treatment.Existing law, the Knox-Keene Health Care Service Plan Act of 1975, 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, until January 1, 2024, would require a health insurer or a health care service plan, not including a Medi-Cal managed care plan, to cover, at a minimum, at least one version of each specified medication-assisted treatment treatment, relapse prevention, and overdose reversal prescription drug approved by the United States Food and Drug Administration for opioid use disorder. The bill would provide that at least one version of each medication-assisted treatment, as identified by a health care service plan or health insurer, relapse prevention, and overdose reversal prescription drug 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, as specified. The bill would specify that its provisions would apply to an FDA-approved drug for use in medication-assisted treatment for opioid use disorder disorder, relapse prevention, or overdose reversal that an enrollee or insured is being prescribed as of January 1, 2019, or, for a new enrollee or insured, that he or she is being prescribed at the time of enrollment. Because a willful violation of those provisions by a health care service plan 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 | |
| 4 | 4 | ||
| 5 | - | ||
| 5 | + | Amended IN Senate August 23, 2018 Amended IN Senate July 03, 2018 Amended IN Senate June 14, 2018 Amended IN Assembly May 25, 2018 Amended IN Assembly May 01, 2018 Amended IN Assembly April 18, 2018 | |
| 6 | 6 | ||
| 7 | - | Enrolled August 31, 2018 | |
| 8 | - | Passed IN Senate August 28, 2018 | |
| 9 | - | Passed IN Assembly August 29, 2018 | |
| 10 | 7 | Amended IN Senate August 23, 2018 | |
| 11 | 8 | Amended IN Senate July 03, 2018 | |
| 12 | 9 | Amended IN Senate June 14, 2018 | |
| 13 | 10 | Amended IN Assembly May 25, 2018 | |
| 14 | 11 | Amended IN Assembly May 01, 2018 | |
| 15 | 12 | Amended IN Assembly April 18, 2018 | |
| 16 | 13 | ||
| 17 | 14 | CALIFORNIA LEGISLATURE 20172018 REGULAR SESSION | |
| 18 | 15 | ||
| 19 | 16 | Assembly Bill No. 2384 | |
| 20 | 17 | ||
| 21 | 18 | Introduced by Assembly Member ArambulaFebruary 14, 2018 | |
| 22 | 19 | ||
| 23 | 20 | Introduced by Assembly Member Arambula | |
| 24 | 21 | February 14, 2018 | |
| 25 | 22 | ||
| 26 | 23 | An act to add and repeal Section 1367.207 of the Health and Safety Code, and to add and repeal Section 10123.204 of the Insurance Code, relating to medication-assisted treatment. | |
| 27 | 24 | ||
| 28 | 25 | LEGISLATIVE COUNSEL'S DIGEST | |
| 29 | 26 | ||
| 30 | 27 | ## LEGISLATIVE COUNSEL'S DIGEST | |
| 31 | 28 | ||
| 32 | - | AB 2384, Arambula. Medication-assisted treatment. | |
| 29 | + | AB 2384, as amended, Arambula. Medication-assisted treatment. | |
| 33 | 30 | ||
| 34 | - | Existing law, the Knox-Keene Health Care Service Plan Act of 1975, 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, until January 1, 2024, would require a health insurer or a health care service plan, not including a Medi-Cal managed care plan, to cover, at a minimum, at least one version of each specified medication-assisted treatment, relapse prevention, and overdose reversal prescription drug approved by the United States Food and Drug Administration for opioid use disorder. The bill would provide that at least one version of each medication-assisted treatment, relapse prevention, and overdose reversal prescription drug 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, as specified. The bill would specify that its provisions would apply to an FDA-approved drug for use in medication-assisted treatment for opioid use disorder, relapse prevention, or overdose reversal that an enrollee or insured is being prescribed as of January 1, 2019, or, for a new enrollee or insured, that he or she is being prescribed at the time of enrollment. Because a willful violation of those provisions by a health care service plan 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. | |
| 31 | + | Existing law, the Knox-Keene Health Care Service Plan Act of 1975, 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, until January 1, 2024, would require a health insurer or a health care service plan, not including a Medi-Cal managed care plan, to cover, at a minimum, at least one version of each specified medication-assisted treatment treatment, relapse prevention, and overdose reversal prescription drug approved by the United States Food and Drug Administration for opioid use disorder. The bill would provide that at least one version of each medication-assisted treatment, as identified by a health care service plan or health insurer, relapse prevention, and overdose reversal prescription drug 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, as specified. The bill would specify that its provisions would apply to an FDA-approved drug for use in medication-assisted treatment for opioid use disorder disorder, relapse prevention, or overdose reversal that an enrollee or insured is being prescribed as of January 1, 2019, or, for a new enrollee or insured, that he or she is being prescribed at the time of enrollment. Because a willful violation of those provisions by a health care service plan 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. | |
| 35 | 32 | ||
| 36 | 33 | Existing law, the Knox-Keene Health Care Service Plan Act of 1975, 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. | |
| 37 | 34 | ||
| 38 | 35 | 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. | |
| 39 | 36 | ||
| 40 | - | This bill, until January 1, 2024, would require a health insurer or a health care service plan, not including a Medi-Cal managed care plan, to cover, at a minimum, at least one version of each specified medication-assisted treatment, relapse prevention, and overdose reversal prescription drug approved by the United States Food and Drug Administration for opioid use disorder. The bill would provide that at least one version of each medication-assisted treatment, relapse prevention, and overdose reversal prescription drug 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, as specified. The bill would specify that its provisions would apply to an FDA-approved drug for use in medication-assisted treatment for opioid use disorder, relapse prevention, or overdose reversal that an enrollee or insured is being prescribed as of January 1, 2019, or, for a new enrollee or insured, that he or she is being prescribed at the time of enrollment. Because a willful violation of those provisions by a health care service plan would be a crime, the bill would impose a state-mandated local program. | |
| 37 | + | This bill, until January 1, 2024, would require a health insurer or a health care service plan, not including a Medi-Cal managed care plan, to cover, at a minimum, at least one version of each specified medication-assisted treatment treatment, relapse prevention, and overdose reversal prescription drug approved by the United States Food and Drug Administration for opioid use disorder. The bill would provide that at least one version of each medication-assisted treatment, as identified by a health care service plan or health insurer, relapse prevention, and overdose reversal prescription drug 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, as specified. The bill would specify that its provisions would apply to an FDA-approved drug for use in medication-assisted treatment for opioid use disorder disorder, relapse prevention, or overdose reversal that an enrollee or insured is being prescribed as of January 1, 2019, or, for a new enrollee or insured, that he or she is being prescribed at the time of enrollment. Because a willful violation of those provisions by a health care service plan would be a crime, the bill would impose a state-mandated local program. | |
| 41 | 38 | ||
| 42 | 39 | 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. | |
| 43 | 40 | ||
| 44 | 41 | This bill would provide that no reimbursement is required by this act for a specified reason. | |
| 45 | 42 | ||
| 46 | 43 | ## Digest Key | |
| 47 | 44 | ||
| 48 | 45 | ## Bill Text | |
| 49 | 46 | ||
| 50 | - | 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 shall cover, at a minimum, at least one version of each of the following medication-assisted treatment, relapse prevention, and overdose reversal prescription drugs approved by the United States Food and Drug Administration (FDA) for opioid use disorder, regardless of whether a drug is self-administered or administered by a health care provider:(1) Buprenorphine.(2) Methadone.(3) Naltrexone.(4) A combination of buprenorphine and naloxone.(5) Naloxone in at least one form of administration approved for community use.(b) Each of the medications listed in subdivision (a) may be substituted for an equivalent drug that is approved by the FDA for medication-assisted treatment, relapse prevention, or overdose reversal, and serves the same medical function as the drug being substituted, if the substitution is consistent with clinical guidelines and peer-reviewed scientific and medical literature.(c) At least one version of each of the five medication-assisted treatment, relapse prevention, and overdose reversal prescription drugs listed in subdivision (a) shall not be subject to the following:(1) Prior authorization.(2) An annual or lifetime dollar limit, if federal restrictions on those limits are amended, revised, or repealed.(3) A requirement that the enrollee receives coverage at an outpatient facility that exceeds allowable time and distance standards for network adequacy, 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.(d) The requirements of this section shall not be subject to an enrollees prior success or failure with medication-assisted treatment.(e) This section applies to an FDA-approved drug for use in medication-assisted treatment for opioid use disorder, relapse prevention, or overdose reversal that an enrollee is being prescribed as of January 1, 2019, or, for a new enrollee, that the new enrollee is being prescribed at the time of enrollment.(f) 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 opioid use disorder. Medication-assisted treatment includes, but is not limited to, pharmacologic therapies with or without 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 opioid use disorder.(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 opioid use disorder, and increase healthy life skills.(4) Financial requirements means a deductible, copayment, coinsurance, or out-of-pocket maximum.(g) For purposes of this section, health care service plan does not include 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, or Medi-Cal managed care plans that provide services pursuant to Chapter 3 (commencing with Section 15850) of Part 3.3 of Division 9 of the Welfare and Institutions Code.(h) This section does not restrict or impair the application of any other provision of this part.(i) This section shall remain in effect only until January 1, 2024, and as of that date is repealed.SEC. 2. Section 10123.204 is added to the Insurance Code, to read:10123.204. (a) A health insurer that provides prescription drug benefits shall cover, at a minimum, at least one version of each of the following medication-assisted treatment, relapse prevention, and overdose reversal prescription drugs approved by the United States Food and Drug Administration (FDA) for opioid use disorder, regardless of whether a drug is self-administered or administered by a health care provider:(1) Buprenorphine.(2) Methadone.(3) Naltrexone.(4) A combination of buprenorphine and naloxone.(5) Naloxone in at least one form of administration approved for community use.(b) Each of the medications listed in subdivision (a) may be substituted for an equivalent drug that is approved by the FDA for medication-assisted treatment, relapse prevention, or overdose reversal, and serves the same medical function as the drug being substituted, if the substitution is consistent with clinical guidelines and peer-reviewed scientific and medical literature.(c) At least one version of each of the five medication-assisted treatment, relapse prevention, and overdose reversal prescription drugs listed in subdivision (a) shall not be subject to the following:(1) Prior authorization.(2) An annual or lifetime dollar limit, if federal restrictions on those limits are amended, revised, or repealed.(3) A requirement that the insured receives coverage at an outpatient facility that exceeds allowable time and distance standards for network adequacy, 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.(d) The requirements of this section shall not be subject to an insureds prior success or failure with medication-assisted treatment.(e) This section applies to an FDA-approved drug for use in medication-assisted treatment for opioid use disorder, relapse prevention, or overdose reversal that an insured is being prescribed as of January 1, 2019, or, for a new insured, that the new insured is being prescribed at the time of enrollment.(f) 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 opioid use disorder. Medication-assisted treatment includes, but is not limited to, pharmacologic therapies with or without 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 opioid use disorder.(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 opioid use disorder, and increase healthy life skills.(4) Financial requirements means a deductible, copayment, coinsurance, or out-of-pocket maximum.(g) This section does not restrict or impair the application of any other provision of this part.(h) This section shall remain in effect only until January 1, 2024, and as of that date is repealed.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. | |
| 47 | + | 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 shall cover, at a minimum, at least one version of each of the following medication-assisted treatment treatment, relapse prevention, and overdose reversal prescription drugs approved by the United States Food and Drug Administration (FDA) for opioid use disorder, regardless of whether a drug is self-administered or administered by a health care provider:(1) Buprenorphine.(2) Methadone.(3) Naltrexone.(4) A combination of buprenorphine and naloxone.(5) Naloxone in at least one form of administration approved for community use.(b) Each of the medications listed in subdivision (a) may be substituted for an equivalent drug that is approved by the FDA for medication-assisted treatment treatment, relapse prevention, or overdose reversal, and serves the same medical function as the drug being substituted. substituted, if the substitution is consistent with clinical guidelines and peer-reviewed scientific and medical literature.(c) Only At least one version of each of the five medication-assisted treatment treatment, relapse prevention, and overdose reversal prescription drugs listed in subdivision (a) and identified by a health care service plan is not shall not be subject to the following:(1) Prior authorization.(2) An annual or lifetime dollar limit, if federal restrictions on those limits are amended, revised, or repealed.(3) A requirement that the enrollee receives coverage at an outpatient facility that exceeds allowable time and distance standards for network adequacy, 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. policies.(d) The requirements of this section shall not be subject to an enrollees prior success or failure with the medication-assisted treatment services provided. treatment.(e) This section applies to an FDA-approved drug for use in medication-assisted treatment for opioid use disorder disorder, relapse prevention, or overdose reversal that an enrollee is being prescribed as of January 1, 2019, or, for a new enrollee, that the new enrollee is being prescribed at the time of enrollment.(f) 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 opioid use disorder. Medication-assisted treatment includes, but is not limited to, pharmacologic therapies with or without 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 opioid use disorder.(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 opioid use disorder, and increase healthy life skills.(4) Financial requirements means a deductible, copayment, coinsurance, or out-of-pocket maximum.(g) For purposes of this section, health care service plan does not include 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. Code, or Medi-Cal managed care plans that provide services pursuant to Chapter 3 (commencing with Section 15850) of Part 3.3 of Division 9 of the Welfare and Institutions Code.(h) This section does not restrict or impair the application of any other provision of this part.(i) This section shall remain in effect only until January 1, 2024, and as of that date is repealed.SEC. 2. Section 10123.204 is added to the Insurance Code, to read:10123.204. (a) A health insurer that provides prescription drug benefits shall cover, at a minimum, at least one version of each of the following medication-assisted treatment treatment, relapse prevention, and overdose reversal prescription drugs approved by the United States Food and Drug Administration (FDA) for opioid use disorder, regardless of whether a drug is self-administered or administered by a health care provider:(1) Buprenorphine.(2) Methadone.(3) Naltrexone.(4) A combination of buprenorphine and naloxone.(5) Naloxone in at least one form of administration approved for community use.(b) Each of the medications listed in subdivision (a) may be substituted for an equivalent drug that is approved by the FDA for medication-assisted treatment treatment, relapse prevention, or overdose reversal, and serves the same medical function as the drug being substituted. substituted, if the substitution is consistent with clinical guidelines and peer-reviewed scientific and medical literature.(c) Only At least one version of each of the five medication-assisted treatment treatment, relapse prevention, and overdose reversal prescription drugs listed in subdivision (a) and identified by a health insurer is not shall not be subject to the following:(1) Prior authorization.(2) An annual or lifetime dollar limit, if federal restrictions on those limits are amended, revised, or repealed.(3) A requirement that the insured receives coverage at an outpatient facility that exceeds allowable time and distance standards for network adequacy, 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. policies.(d) The requirements of this section shall not be subject to an insureds prior success or failure with the medication-assisted treatment services provided. treatment.(e) This section applies to an FDA-approved drug for use in medication-assisted treatment for opioid use disorder disorder, relapse prevention, or overdose reversal that an insured is being prescribed as of January 1, 2019, or, for a new insured, that the new insured is being prescribed at the time of enrollment.(f) 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 opioid use disorder. Medication-assisted treatment includes, but is not limited to, pharmacologic therapies with or without 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 opioid use disorder.(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 opioid use disorder, and increase healthy life skills.(4) Financial requirements means a deductible, copayment, coinsurance, or out-of-pocket maximum.(g) This section does not restrict or impair the application of any other provision of this part.(h) This section shall remain in effect only until January 1, 2024, and as of that date is repealed.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. | |
| 51 | 48 | ||
| 52 | 49 | The people of the State of California do enact as follows: | |
| 53 | 50 | ||
| 54 | 51 | ## The people of the State of California do enact as follows: | |
| 55 | 52 | ||
| 56 | - | 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 shall cover, at a minimum, at least one version of each of the following medication-assisted treatment, relapse prevention, and overdose reversal prescription drugs approved by the United States Food and Drug Administration (FDA) for opioid use disorder, regardless of whether a drug is self-administered or administered by a health care provider:(1) Buprenorphine.(2) Methadone.(3) Naltrexone.(4) A combination of buprenorphine and naloxone.(5) Naloxone in at least one form of administration approved for community use.(b) Each of the medications listed in subdivision (a) may be substituted for an equivalent drug that is approved by the FDA for medication-assisted treatment, relapse prevention, or overdose reversal, and serves the same medical function as the drug being substituted, if the substitution is consistent with clinical guidelines and peer-reviewed scientific and medical literature.(c) At least one version of each of the five medication-assisted treatment, relapse prevention, and overdose reversal prescription drugs listed in subdivision (a) shall not be subject to the following:(1) Prior authorization.(2) An annual or lifetime dollar limit, if federal restrictions on those limits are amended, revised, or repealed.(3) A requirement that the enrollee receives coverage at an outpatient facility that exceeds allowable time and distance standards for network adequacy, 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.(d) The requirements of this section shall not be subject to an enrollees prior success or failure with medication-assisted treatment.(e) This section applies to an FDA-approved drug for use in medication-assisted treatment for opioid use disorder, relapse prevention, or overdose reversal that an enrollee is being prescribed as of January 1, 2019, or, for a new enrollee, that the new enrollee is being prescribed at the time of enrollment.(f) 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 opioid use disorder. Medication-assisted treatment includes, but is not limited to, pharmacologic therapies with or without 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 opioid use disorder.(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 opioid use disorder, and increase healthy life skills.(4) Financial requirements means a deductible, copayment, coinsurance, or out-of-pocket maximum.(g) For purposes of this section, health care service plan does not include 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, or Medi-Cal managed care plans that provide services pursuant to Chapter 3 (commencing with Section 15850) of Part 3.3 of Division 9 of the Welfare and Institutions Code.(h) This section does not restrict or impair the application of any other provision of this part.(i) This section shall remain in effect only until January 1, 2024, and as of that date is repealed. | |
| 53 | + | 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 shall cover, at a minimum, at least one version of each of the following medication-assisted treatment treatment, relapse prevention, and overdose reversal prescription drugs approved by the United States Food and Drug Administration (FDA) for opioid use disorder, regardless of whether a drug is self-administered or administered by a health care provider:(1) Buprenorphine.(2) Methadone.(3) Naltrexone.(4) A combination of buprenorphine and naloxone.(5) Naloxone in at least one form of administration approved for community use.(b) Each of the medications listed in subdivision (a) may be substituted for an equivalent drug that is approved by the FDA for medication-assisted treatment treatment, relapse prevention, or overdose reversal, and serves the same medical function as the drug being substituted. substituted, if the substitution is consistent with clinical guidelines and peer-reviewed scientific and medical literature.(c) Only At least one version of each of the five medication-assisted treatment treatment, relapse prevention, and overdose reversal prescription drugs listed in subdivision (a) and identified by a health care service plan is not shall not be subject to the following:(1) Prior authorization.(2) An annual or lifetime dollar limit, if federal restrictions on those limits are amended, revised, or repealed.(3) A requirement that the enrollee receives coverage at an outpatient facility that exceeds allowable time and distance standards for network adequacy, 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. policies.(d) The requirements of this section shall not be subject to an enrollees prior success or failure with the medication-assisted treatment services provided. treatment.(e) This section applies to an FDA-approved drug for use in medication-assisted treatment for opioid use disorder disorder, relapse prevention, or overdose reversal that an enrollee is being prescribed as of January 1, 2019, or, for a new enrollee, that the new enrollee is being prescribed at the time of enrollment.(f) 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 opioid use disorder. Medication-assisted treatment includes, but is not limited to, pharmacologic therapies with or without 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 opioid use disorder.(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 opioid use disorder, and increase healthy life skills.(4) Financial requirements means a deductible, copayment, coinsurance, or out-of-pocket maximum.(g) For purposes of this section, health care service plan does not include 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. Code, or Medi-Cal managed care plans that provide services pursuant to Chapter 3 (commencing with Section 15850) of Part 3.3 of Division 9 of the Welfare and Institutions Code.(h) This section does not restrict or impair the application of any other provision of this part.(i) This section shall remain in effect only until January 1, 2024, and as of that date is repealed. | |
| 57 | 54 | ||
| 58 | 55 | SECTION 1. Section 1367.207 is added to the Health and Safety Code, to read: | |
| 59 | 56 | ||
| 60 | 57 | ### SECTION 1. | |
| 61 | 58 | ||
| 62 | - | 1367.207. (a) A health care service plan that provides prescription drug benefits shall cover, at a minimum, at least one version of each of the following medication-assisted treatment, relapse prevention, and overdose reversal prescription drugs approved by the United States Food and Drug Administration (FDA) for opioid use disorder, regardless of whether a drug is self-administered or administered by a health care provider:(1) Buprenorphine.(2) Methadone.(3) Naltrexone.(4) A combination of buprenorphine and naloxone.(5) Naloxone in at least one form of administration approved for community use.(b) Each of the medications listed in subdivision (a) may be substituted for an equivalent drug that is approved by the FDA for medication-assisted treatment, relapse prevention, or overdose reversal, and serves the same medical function as the drug being substituted, if the substitution is consistent with clinical guidelines and peer-reviewed scientific and medical literature.(c) At least one version of each of the five medication-assisted treatment, relapse prevention, and overdose reversal prescription drugs listed in subdivision (a) shall not be subject to the following:(1) Prior authorization.(2) An annual or lifetime dollar limit, if federal restrictions on those limits are amended, revised, or repealed.(3) A requirement that the enrollee receives coverage at an outpatient facility that exceeds allowable time and distance standards for network adequacy, 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.(d) The requirements of this section shall not be subject to an enrollees prior success or failure with medication-assisted treatment.(e) This section applies to an FDA-approved drug for use in medication-assisted treatment for opioid use disorder, relapse prevention, or overdose reversal that an enrollee is being prescribed as of January 1, 2019, or, for a new enrollee, that the new enrollee is being prescribed at the time of enrollment.(f) 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 opioid use disorder. Medication-assisted treatment includes, but is not limited to, pharmacologic therapies with or without 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 opioid use disorder.(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 opioid use disorder, and increase healthy life skills.(4) Financial requirements means a deductible, copayment, coinsurance, or out-of-pocket maximum.(g) For purposes of this section, health care service plan does not include 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, or Medi-Cal managed care plans that provide services pursuant to Chapter 3 (commencing with Section 15850) of Part 3.3 of Division 9 of the Welfare and Institutions Code.(h) This section does not restrict or impair the application of any other provision of this part.(i) This section shall remain in effect only until January 1, 2024, and as of that date is repealed. | |
| 59 | + | 1367.207. (a) A health care service plan that provides prescription drug benefits shall cover, at a minimum, at least one version of each of the following medication-assisted treatment treatment, relapse prevention, and overdose reversal prescription drugs approved by the United States Food and Drug Administration (FDA) for opioid use disorder, regardless of whether a drug is self-administered or administered by a health care provider:(1) Buprenorphine.(2) Methadone.(3) Naltrexone.(4) A combination of buprenorphine and naloxone.(5) Naloxone in at least one form of administration approved for community use.(b) Each of the medications listed in subdivision (a) may be substituted for an equivalent drug that is approved by the FDA for medication-assisted treatment treatment, relapse prevention, or overdose reversal, and serves the same medical function as the drug being substituted. substituted, if the substitution is consistent with clinical guidelines and peer-reviewed scientific and medical literature.(c) Only At least one version of each of the five medication-assisted treatment treatment, relapse prevention, and overdose reversal prescription drugs listed in subdivision (a) and identified by a health care service plan is not shall not be subject to the following:(1) Prior authorization.(2) An annual or lifetime dollar limit, if federal restrictions on those limits are amended, revised, or repealed.(3) A requirement that the enrollee receives coverage at an outpatient facility that exceeds allowable time and distance standards for network adequacy, 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. policies.(d) The requirements of this section shall not be subject to an enrollees prior success or failure with the medication-assisted treatment services provided. treatment.(e) This section applies to an FDA-approved drug for use in medication-assisted treatment for opioid use disorder disorder, relapse prevention, or overdose reversal that an enrollee is being prescribed as of January 1, 2019, or, for a new enrollee, that the new enrollee is being prescribed at the time of enrollment.(f) 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 opioid use disorder. Medication-assisted treatment includes, but is not limited to, pharmacologic therapies with or without 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 opioid use disorder.(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 opioid use disorder, and increase healthy life skills.(4) Financial requirements means a deductible, copayment, coinsurance, or out-of-pocket maximum.(g) For purposes of this section, health care service plan does not include 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. Code, or Medi-Cal managed care plans that provide services pursuant to Chapter 3 (commencing with Section 15850) of Part 3.3 of Division 9 of the Welfare and Institutions Code.(h) This section does not restrict or impair the application of any other provision of this part.(i) This section shall remain in effect only until January 1, 2024, and as of that date is repealed. | |
| 63 | 60 | ||
| 64 | - | 1367.207. (a) A health care service plan that provides prescription drug benefits shall cover, at a minimum, at least one version of each of the following medication-assisted treatment, relapse prevention, and overdose reversal prescription drugs approved by the United States Food and Drug Administration (FDA) for opioid use disorder, regardless of whether a drug is self-administered or administered by a health care provider:(1) Buprenorphine.(2) Methadone.(3) Naltrexone.(4) A combination of buprenorphine and naloxone.(5) Naloxone in at least one form of administration approved for community use.(b) Each of the medications listed in subdivision (a) may be substituted for an equivalent drug that is approved by the FDA for medication-assisted treatment, relapse prevention, or overdose reversal, and serves the same medical function as the drug being substituted, if the substitution is consistent with clinical guidelines and peer-reviewed scientific and medical literature.(c) At least one version of each of the five medication-assisted treatment, relapse prevention, and overdose reversal prescription drugs listed in subdivision (a) shall not be subject to the following:(1) Prior authorization.(2) An annual or lifetime dollar limit, if federal restrictions on those limits are amended, revised, or repealed.(3) A requirement that the enrollee receives coverage at an outpatient facility that exceeds allowable time and distance standards for network adequacy, 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.(d) The requirements of this section shall not be subject to an enrollees prior success or failure with medication-assisted treatment.(e) This section applies to an FDA-approved drug for use in medication-assisted treatment for opioid use disorder, relapse prevention, or overdose reversal that an enrollee is being prescribed as of January 1, 2019, or, for a new enrollee, that the new enrollee is being prescribed at the time of enrollment.(f) 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 opioid use disorder. Medication-assisted treatment includes, but is not limited to, pharmacologic therapies with or without 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 opioid use disorder.(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 opioid use disorder, and increase healthy life skills.(4) Financial requirements means a deductible, copayment, coinsurance, or out-of-pocket maximum.(g) For purposes of this section, health care service plan does not include 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, or Medi-Cal managed care plans that provide services pursuant to Chapter 3 (commencing with Section 15850) of Part 3.3 of Division 9 of the Welfare and Institutions Code.(h) This section does not restrict or impair the application of any other provision of this part.(i) This section shall remain in effect only until January 1, 2024, and as of that date is repealed. | |
| 61 | + | 1367.207. (a) A health care service plan that provides prescription drug benefits shall cover, at a minimum, at least one version of each of the following medication-assisted treatment treatment, relapse prevention, and overdose reversal prescription drugs approved by the United States Food and Drug Administration (FDA) for opioid use disorder, regardless of whether a drug is self-administered or administered by a health care provider:(1) Buprenorphine.(2) Methadone.(3) Naltrexone.(4) A combination of buprenorphine and naloxone.(5) Naloxone in at least one form of administration approved for community use.(b) Each of the medications listed in subdivision (a) may be substituted for an equivalent drug that is approved by the FDA for medication-assisted treatment treatment, relapse prevention, or overdose reversal, and serves the same medical function as the drug being substituted. substituted, if the substitution is consistent with clinical guidelines and peer-reviewed scientific and medical literature.(c) Only At least one version of each of the five medication-assisted treatment treatment, relapse prevention, and overdose reversal prescription drugs listed in subdivision (a) and identified by a health care service plan is not shall not be subject to the following:(1) Prior authorization.(2) An annual or lifetime dollar limit, if federal restrictions on those limits are amended, revised, or repealed.(3) A requirement that the enrollee receives coverage at an outpatient facility that exceeds allowable time and distance standards for network adequacy, 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. policies.(d) The requirements of this section shall not be subject to an enrollees prior success or failure with the medication-assisted treatment services provided. treatment.(e) This section applies to an FDA-approved drug for use in medication-assisted treatment for opioid use disorder disorder, relapse prevention, or overdose reversal that an enrollee is being prescribed as of January 1, 2019, or, for a new enrollee, that the new enrollee is being prescribed at the time of enrollment.(f) 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 opioid use disorder. Medication-assisted treatment includes, but is not limited to, pharmacologic therapies with or without 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 opioid use disorder.(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 opioid use disorder, and increase healthy life skills.(4) Financial requirements means a deductible, copayment, coinsurance, or out-of-pocket maximum.(g) For purposes of this section, health care service plan does not include 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. Code, or Medi-Cal managed care plans that provide services pursuant to Chapter 3 (commencing with Section 15850) of Part 3.3 of Division 9 of the Welfare and Institutions Code.(h) This section does not restrict or impair the application of any other provision of this part.(i) This section shall remain in effect only until January 1, 2024, and as of that date is repealed. | |
| 65 | 62 | ||
| 66 | - | 1367.207. (a) A health care service plan that provides prescription drug benefits shall cover, at a minimum, at least one version of each of the following medication-assisted treatment, relapse prevention, and overdose reversal prescription drugs approved by the United States Food and Drug Administration (FDA) for opioid use disorder, regardless of whether a drug is self-administered or administered by a health care provider:(1) Buprenorphine.(2) Methadone.(3) Naltrexone.(4) A combination of buprenorphine and naloxone.(5) Naloxone in at least one form of administration approved for community use.(b) Each of the medications listed in subdivision (a) may be substituted for an equivalent drug that is approved by the FDA for medication-assisted treatment, relapse prevention, or overdose reversal, and serves the same medical function as the drug being substituted, if the substitution is consistent with clinical guidelines and peer-reviewed scientific and medical literature.(c) At least one version of each of the five medication-assisted treatment, relapse prevention, and overdose reversal prescription drugs listed in subdivision (a) shall not be subject to the following:(1) Prior authorization.(2) An annual or lifetime dollar limit, if federal restrictions on those limits are amended, revised, or repealed.(3) A requirement that the enrollee receives coverage at an outpatient facility that exceeds allowable time and distance standards for network adequacy, 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.(d) The requirements of this section shall not be subject to an enrollees prior success or failure with medication-assisted treatment.(e) This section applies to an FDA-approved drug for use in medication-assisted treatment for opioid use disorder, relapse prevention, or overdose reversal that an enrollee is being prescribed as of January 1, 2019, or, for a new enrollee, that the new enrollee is being prescribed at the time of enrollment.(f) 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 opioid use disorder. Medication-assisted treatment includes, but is not limited to, pharmacologic therapies with or without 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 opioid use disorder.(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 opioid use disorder, and increase healthy life skills.(4) Financial requirements means a deductible, copayment, coinsurance, or out-of-pocket maximum.(g) For purposes of this section, health care service plan does not include 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, or Medi-Cal managed care plans that provide services pursuant to Chapter 3 (commencing with Section 15850) of Part 3.3 of Division 9 of the Welfare and Institutions Code.(h) This section does not restrict or impair the application of any other provision of this part.(i) This section shall remain in effect only until January 1, 2024, and as of that date is repealed. | |
| 63 | + | 1367.207. (a) A health care service plan that provides prescription drug benefits shall cover, at a minimum, at least one version of each of the following medication-assisted treatment treatment, relapse prevention, and overdose reversal prescription drugs approved by the United States Food and Drug Administration (FDA) for opioid use disorder, regardless of whether a drug is self-administered or administered by a health care provider:(1) Buprenorphine.(2) Methadone.(3) Naltrexone.(4) A combination of buprenorphine and naloxone.(5) Naloxone in at least one form of administration approved for community use.(b) Each of the medications listed in subdivision (a) may be substituted for an equivalent drug that is approved by the FDA for medication-assisted treatment treatment, relapse prevention, or overdose reversal, and serves the same medical function as the drug being substituted. substituted, if the substitution is consistent with clinical guidelines and peer-reviewed scientific and medical literature.(c) Only At least one version of each of the five medication-assisted treatment treatment, relapse prevention, and overdose reversal prescription drugs listed in subdivision (a) and identified by a health care service plan is not shall not be subject to the following:(1) Prior authorization.(2) An annual or lifetime dollar limit, if federal restrictions on those limits are amended, revised, or repealed.(3) A requirement that the enrollee receives coverage at an outpatient facility that exceeds allowable time and distance standards for network adequacy, 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. policies.(d) The requirements of this section shall not be subject to an enrollees prior success or failure with the medication-assisted treatment services provided. treatment.(e) This section applies to an FDA-approved drug for use in medication-assisted treatment for opioid use disorder disorder, relapse prevention, or overdose reversal that an enrollee is being prescribed as of January 1, 2019, or, for a new enrollee, that the new enrollee is being prescribed at the time of enrollment.(f) 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 opioid use disorder. Medication-assisted treatment includes, but is not limited to, pharmacologic therapies with or without 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 opioid use disorder.(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 opioid use disorder, and increase healthy life skills.(4) Financial requirements means a deductible, copayment, coinsurance, or out-of-pocket maximum.(g) For purposes of this section, health care service plan does not include 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. Code, or Medi-Cal managed care plans that provide services pursuant to Chapter 3 (commencing with Section 15850) of Part 3.3 of Division 9 of the Welfare and Institutions Code.(h) This section does not restrict or impair the application of any other provision of this part.(i) This section shall remain in effect only until January 1, 2024, and as of that date is repealed. | |
| 67 | 64 | ||
| 68 | 65 | ||
| 69 | 66 | ||
| 70 | - | 1367.207. (a) A health care service plan that provides prescription drug benefits shall cover, at a minimum, at least one version of each of the following medication-assisted treatment, relapse prevention, and overdose reversal prescription drugs approved by the United States Food and Drug Administration (FDA) for opioid use disorder, regardless of whether a drug is self-administered or administered by a health care provider: | |
| 67 | + | 1367.207. (a) A health care service plan that provides prescription drug benefits shall cover, at a minimum, at least one version of each of the following medication-assisted treatment treatment, relapse prevention, and overdose reversal prescription drugs approved by the United States Food and Drug Administration (FDA) for opioid use disorder, regardless of whether a drug is self-administered or administered by a health care provider: | |
| 71 | 68 | ||
| 72 | 69 | (1) Buprenorphine. | |
| 73 | 70 | ||
| 74 | 71 | (2) Methadone. | |
| 75 | 72 | ||
| 76 | 73 | (3) Naltrexone. | |
| 77 | 74 | ||
| 78 | 75 | (4) A combination of buprenorphine and naloxone. | |
| 79 | 76 | ||
| 80 | 77 | (5) Naloxone in at least one form of administration approved for community use. | |
| 81 | 78 | ||
| 82 | - | (b) Each of the medications listed in subdivision (a) may be substituted for an equivalent drug that is approved by the FDA for medication-assisted treatment, relapse prevention, or overdose reversal, and serves the same medical function as the drug being substituted, if the substitution is consistent with clinical guidelines and peer-reviewed scientific and medical literature. | |
| 79 | + | (b) Each of the medications listed in subdivision (a) may be substituted for an equivalent drug that is approved by the FDA for medication-assisted treatment treatment, relapse prevention, or overdose reversal, and serves the same medical function as the drug being substituted. substituted, if the substitution is consistent with clinical guidelines and peer-reviewed scientific and medical literature. | |
| 83 | 80 | ||
| 84 | - | (c) At least one version of each of the five medication-assisted treatment, relapse prevention, and overdose reversal prescription drugs listed in subdivision (a) shall not be subject to the following: | |
| 81 | + | (c) Only At least one version of each of the five medication-assisted treatment treatment, relapse prevention, and overdose reversal prescription drugs listed in subdivision (a) and identified by a health care service plan is not shall not be subject to the following: | |
| 85 | 82 | ||
| 86 | 83 | (1) Prior authorization. | |
| 87 | 84 | ||
| 88 | 85 | (2) An annual or lifetime dollar limit, if federal restrictions on those limits are amended, revised, or repealed. | |
| 89 | 86 | ||
| 90 | 87 | (3) A requirement that the enrollee receives coverage at an outpatient facility that exceeds allowable time and distance standards for network adequacy, a specific number of visits, days of coverage, scope or duration of treatment, or other similar limitations. | |
| 91 | 88 | ||
| 92 | 89 | (4) Financial requirements different than those for other illnesses covered under the health care service plan. | |
| 93 | 90 | ||
| 94 | - | (5) Step therapy, fail first policies, or other similar drug utilization strategies or policies. | |
| 91 | + | (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. policies. | |
| 95 | 92 | ||
| 96 | - | (d) The requirements of this section shall not be subject to an enrollees prior success or failure with medication-assisted treatment. | |
| 93 | + | (d) The requirements of this section shall not be subject to an enrollees prior success or failure with the medication-assisted treatment services provided. treatment. | |
| 97 | 94 | ||
| 98 | - | (e) This section applies to an FDA-approved drug for use in medication-assisted treatment for opioid use disorder, relapse prevention, or overdose reversal that an enrollee is being prescribed as of January 1, 2019, or, for a new enrollee, that the new enrollee is being prescribed at the time of enrollment. | |
| 95 | + | (e) This section applies to an FDA-approved drug for use in medication-assisted treatment for opioid use disorder disorder, relapse prevention, or overdose reversal that an enrollee is being prescribed as of January 1, 2019, or, for a new enrollee, that the new enrollee is being prescribed at the time of enrollment. | |
| 99 | 96 | ||
| 100 | 97 | (f) For purposes of this section, the following definitions apply: | |
| 101 | 98 | ||
| 102 | 99 | (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 opioid use disorder. Medication-assisted treatment includes, but is not limited to, pharmacologic therapies with or without behavioral therapies. | |
| 103 | 100 | ||
| 104 | 101 | (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 opioid use disorder. | |
| 105 | 102 | ||
| 106 | 103 | (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 opioid use disorder, and increase healthy life skills. | |
| 107 | 104 | ||
| 108 | 105 | (4) Financial requirements means a deductible, copayment, coinsurance, or out-of-pocket maximum. | |
| 109 | 106 | ||
| 110 | - | (g) For purposes of this section, health care service plan does not include 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, or Medi-Cal managed care plans that provide services pursuant to Chapter 3 (commencing with Section 15850) of Part 3.3 of Division 9 of the Welfare and Institutions Code. | |
| 107 | + | (g) For purposes of this section, health care service plan does not include 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. Code, or Medi-Cal managed care plans that provide services pursuant to Chapter 3 (commencing with Section 15850) of Part 3.3 of Division 9 of the Welfare and Institutions Code. | |
| 111 | 108 | ||
| 112 | 109 | (h) This section does not restrict or impair the application of any other provision of this part. | |
| 113 | 110 | ||
| 114 | 111 | (i) This section shall remain in effect only until January 1, 2024, and as of that date is repealed. | |
| 115 | 112 | ||
| 116 | - | SEC. 2. Section 10123.204 is added to the Insurance Code, to read:10123.204. (a) A health insurer that provides prescription drug benefits shall cover, at a minimum, at least one version of each of the following medication-assisted treatment, relapse prevention, and overdose reversal prescription drugs approved by the United States Food and Drug Administration (FDA) for opioid use disorder, regardless of whether a drug is self-administered or administered by a health care provider:(1) Buprenorphine.(2) Methadone.(3) Naltrexone.(4) A combination of buprenorphine and naloxone.(5) Naloxone in at least one form of administration approved for community use.(b) Each of the medications listed in subdivision (a) may be substituted for an equivalent drug that is approved by the FDA for medication-assisted treatment, relapse prevention, or overdose reversal, and serves the same medical function as the drug being substituted, if the substitution is consistent with clinical guidelines and peer-reviewed scientific and medical literature.(c) At least one version of each of the five medication-assisted treatment, relapse prevention, and overdose reversal prescription drugs listed in subdivision (a) shall not be subject to the following:(1) Prior authorization.(2) An annual or lifetime dollar limit, if federal restrictions on those limits are amended, revised, or repealed.(3) A requirement that the insured receives coverage at an outpatient facility that exceeds allowable time and distance standards for network adequacy, 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.(d) The requirements of this section shall not be subject to an insureds prior success or failure with medication-assisted treatment.(e) This section applies to an FDA-approved drug for use in medication-assisted treatment for opioid use disorder, relapse prevention, or overdose reversal that an insured is being prescribed as of January 1, 2019, or, for a new insured, that the new insured is being prescribed at the time of enrollment.(f) 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 opioid use disorder. Medication-assisted treatment includes, but is not limited to, pharmacologic therapies with or without 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 opioid use disorder.(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 opioid use disorder, and increase healthy life skills.(4) Financial requirements means a deductible, copayment, coinsurance, or out-of-pocket maximum.(g) This section does not restrict or impair the application of any other provision of this part.(h) This section shall remain in effect only until January 1, 2024, and as of that date is repealed. | |
| 113 | + | SEC. 2. Section 10123.204 is added to the Insurance Code, to read:10123.204. (a) A health insurer that provides prescription drug benefits shall cover, at a minimum, at least one version of each of the following medication-assisted treatment treatment, relapse prevention, and overdose reversal prescription drugs approved by the United States Food and Drug Administration (FDA) for opioid use disorder, regardless of whether a drug is self-administered or administered by a health care provider:(1) Buprenorphine.(2) Methadone.(3) Naltrexone.(4) A combination of buprenorphine and naloxone.(5) Naloxone in at least one form of administration approved for community use.(b) Each of the medications listed in subdivision (a) may be substituted for an equivalent drug that is approved by the FDA for medication-assisted treatment treatment, relapse prevention, or overdose reversal, and serves the same medical function as the drug being substituted. substituted, if the substitution is consistent with clinical guidelines and peer-reviewed scientific and medical literature.(c) Only At least one version of each of the five medication-assisted treatment treatment, relapse prevention, and overdose reversal prescription drugs listed in subdivision (a) and identified by a health insurer is not shall not be subject to the following:(1) Prior authorization.(2) An annual or lifetime dollar limit, if federal restrictions on those limits are amended, revised, or repealed.(3) A requirement that the insured receives coverage at an outpatient facility that exceeds allowable time and distance standards for network adequacy, 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. policies.(d) The requirements of this section shall not be subject to an insureds prior success or failure with the medication-assisted treatment services provided. treatment.(e) This section applies to an FDA-approved drug for use in medication-assisted treatment for opioid use disorder disorder, relapse prevention, or overdose reversal that an insured is being prescribed as of January 1, 2019, or, for a new insured, that the new insured is being prescribed at the time of enrollment.(f) 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 opioid use disorder. Medication-assisted treatment includes, but is not limited to, pharmacologic therapies with or without 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 opioid use disorder.(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 opioid use disorder, and increase healthy life skills.(4) Financial requirements means a deductible, copayment, coinsurance, or out-of-pocket maximum.(g) This section does not restrict or impair the application of any other provision of this part.(h) This section shall remain in effect only until January 1, 2024, and as of that date is repealed. | |
| 117 | 114 | ||
| 118 | 115 | SEC. 2. Section 10123.204 is added to the Insurance Code, to read: | |
| 119 | 116 | ||
| 120 | 117 | ### SEC. 2. | |
| 121 | 118 | ||
| 122 | - | 10123.204. (a) A health insurer that provides prescription drug benefits shall cover, at a minimum, at least one version of each of the following medication-assisted treatment, relapse prevention, and overdose reversal prescription drugs approved by the United States Food and Drug Administration (FDA) for opioid use disorder, regardless of whether a drug is self-administered or administered by a health care provider:(1) Buprenorphine.(2) Methadone.(3) Naltrexone.(4) A combination of buprenorphine and naloxone.(5) Naloxone in at least one form of administration approved for community use.(b) Each of the medications listed in subdivision (a) may be substituted for an equivalent drug that is approved by the FDA for medication-assisted treatment, relapse prevention, or overdose reversal, and serves the same medical function as the drug being substituted, if the substitution is consistent with clinical guidelines and peer-reviewed scientific and medical literature.(c) At least one version of each of the five medication-assisted treatment, relapse prevention, and overdose reversal prescription drugs listed in subdivision (a) shall not be subject to the following:(1) Prior authorization.(2) An annual or lifetime dollar limit, if federal restrictions on those limits are amended, revised, or repealed.(3) A requirement that the insured receives coverage at an outpatient facility that exceeds allowable time and distance standards for network adequacy, 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.(d) The requirements of this section shall not be subject to an insureds prior success or failure with medication-assisted treatment.(e) This section applies to an FDA-approved drug for use in medication-assisted treatment for opioid use disorder, relapse prevention, or overdose reversal that an insured is being prescribed as of January 1, 2019, or, for a new insured, that the new insured is being prescribed at the time of enrollment.(f) 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 opioid use disorder. Medication-assisted treatment includes, but is not limited to, pharmacologic therapies with or without 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 opioid use disorder.(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 opioid use disorder, and increase healthy life skills.(4) Financial requirements means a deductible, copayment, coinsurance, or out-of-pocket maximum.(g) This section does not restrict or impair the application of any other provision of this part.(h) This section shall remain in effect only until January 1, 2024, and as of that date is repealed. | |
| 119 | + | 10123.204. (a) A health insurer that provides prescription drug benefits shall cover, at a minimum, at least one version of each of the following medication-assisted treatment treatment, relapse prevention, and overdose reversal prescription drugs approved by the United States Food and Drug Administration (FDA) for opioid use disorder, regardless of whether a drug is self-administered or administered by a health care provider:(1) Buprenorphine.(2) Methadone.(3) Naltrexone.(4) A combination of buprenorphine and naloxone.(5) Naloxone in at least one form of administration approved for community use.(b) Each of the medications listed in subdivision (a) may be substituted for an equivalent drug that is approved by the FDA for medication-assisted treatment treatment, relapse prevention, or overdose reversal, and serves the same medical function as the drug being substituted. substituted, if the substitution is consistent with clinical guidelines and peer-reviewed scientific and medical literature.(c) Only At least one version of each of the five medication-assisted treatment treatment, relapse prevention, and overdose reversal prescription drugs listed in subdivision (a) and identified by a health insurer is not shall not be subject to the following:(1) Prior authorization.(2) An annual or lifetime dollar limit, if federal restrictions on those limits are amended, revised, or repealed.(3) A requirement that the insured receives coverage at an outpatient facility that exceeds allowable time and distance standards for network adequacy, 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. policies.(d) The requirements of this section shall not be subject to an insureds prior success or failure with the medication-assisted treatment services provided. treatment.(e) This section applies to an FDA-approved drug for use in medication-assisted treatment for opioid use disorder disorder, relapse prevention, or overdose reversal that an insured is being prescribed as of January 1, 2019, or, for a new insured, that the new insured is being prescribed at the time of enrollment.(f) 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 opioid use disorder. Medication-assisted treatment includes, but is not limited to, pharmacologic therapies with or without 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 opioid use disorder.(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 opioid use disorder, and increase healthy life skills.(4) Financial requirements means a deductible, copayment, coinsurance, or out-of-pocket maximum.(g) This section does not restrict or impair the application of any other provision of this part.(h) This section shall remain in effect only until January 1, 2024, and as of that date is repealed. | |
| 123 | 120 | ||
| 124 | - | 10123.204. (a) A health insurer that provides prescription drug benefits shall cover, at a minimum, at least one version of each of the following medication-assisted treatment, relapse prevention, and overdose reversal prescription drugs approved by the United States Food and Drug Administration (FDA) for opioid use disorder, regardless of whether a drug is self-administered or administered by a health care provider:(1) Buprenorphine.(2) Methadone.(3) Naltrexone.(4) A combination of buprenorphine and naloxone.(5) Naloxone in at least one form of administration approved for community use.(b) Each of the medications listed in subdivision (a) may be substituted for an equivalent drug that is approved by the FDA for medication-assisted treatment, relapse prevention, or overdose reversal, and serves the same medical function as the drug being substituted, if the substitution is consistent with clinical guidelines and peer-reviewed scientific and medical literature.(c) At least one version of each of the five medication-assisted treatment, relapse prevention, and overdose reversal prescription drugs listed in subdivision (a) shall not be subject to the following:(1) Prior authorization.(2) An annual or lifetime dollar limit, if federal restrictions on those limits are amended, revised, or repealed.(3) A requirement that the insured receives coverage at an outpatient facility that exceeds allowable time and distance standards for network adequacy, 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.(d) The requirements of this section shall not be subject to an insureds prior success or failure with medication-assisted treatment.(e) This section applies to an FDA-approved drug for use in medication-assisted treatment for opioid use disorder, relapse prevention, or overdose reversal that an insured is being prescribed as of January 1, 2019, or, for a new insured, that the new insured is being prescribed at the time of enrollment.(f) 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 opioid use disorder. Medication-assisted treatment includes, but is not limited to, pharmacologic therapies with or without 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 opioid use disorder.(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 opioid use disorder, and increase healthy life skills.(4) Financial requirements means a deductible, copayment, coinsurance, or out-of-pocket maximum.(g) This section does not restrict or impair the application of any other provision of this part.(h) This section shall remain in effect only until January 1, 2024, and as of that date is repealed. | |
| 121 | + | 10123.204. (a) A health insurer that provides prescription drug benefits shall cover, at a minimum, at least one version of each of the following medication-assisted treatment treatment, relapse prevention, and overdose reversal prescription drugs approved by the United States Food and Drug Administration (FDA) for opioid use disorder, regardless of whether a drug is self-administered or administered by a health care provider:(1) Buprenorphine.(2) Methadone.(3) Naltrexone.(4) A combination of buprenorphine and naloxone.(5) Naloxone in at least one form of administration approved for community use.(b) Each of the medications listed in subdivision (a) may be substituted for an equivalent drug that is approved by the FDA for medication-assisted treatment treatment, relapse prevention, or overdose reversal, and serves the same medical function as the drug being substituted. substituted, if the substitution is consistent with clinical guidelines and peer-reviewed scientific and medical literature.(c) Only At least one version of each of the five medication-assisted treatment treatment, relapse prevention, and overdose reversal prescription drugs listed in subdivision (a) and identified by a health insurer is not shall not be subject to the following:(1) Prior authorization.(2) An annual or lifetime dollar limit, if federal restrictions on those limits are amended, revised, or repealed.(3) A requirement that the insured receives coverage at an outpatient facility that exceeds allowable time and distance standards for network adequacy, 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. policies.(d) The requirements of this section shall not be subject to an insureds prior success or failure with the medication-assisted treatment services provided. treatment.(e) This section applies to an FDA-approved drug for use in medication-assisted treatment for opioid use disorder disorder, relapse prevention, or overdose reversal that an insured is being prescribed as of January 1, 2019, or, for a new insured, that the new insured is being prescribed at the time of enrollment.(f) 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 opioid use disorder. Medication-assisted treatment includes, but is not limited to, pharmacologic therapies with or without 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 opioid use disorder.(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 opioid use disorder, and increase healthy life skills.(4) Financial requirements means a deductible, copayment, coinsurance, or out-of-pocket maximum.(g) This section does not restrict or impair the application of any other provision of this part.(h) This section shall remain in effect only until January 1, 2024, and as of that date is repealed. | |
| 125 | 122 | ||
| 126 | - | 10123.204. (a) A health insurer that provides prescription drug benefits shall cover, at a minimum, at least one version of each of the following medication-assisted treatment, relapse prevention, and overdose reversal prescription drugs approved by the United States Food and Drug Administration (FDA) for opioid use disorder, regardless of whether a drug is self-administered or administered by a health care provider:(1) Buprenorphine.(2) Methadone.(3) Naltrexone.(4) A combination of buprenorphine and naloxone.(5) Naloxone in at least one form of administration approved for community use.(b) Each of the medications listed in subdivision (a) may be substituted for an equivalent drug that is approved by the FDA for medication-assisted treatment, relapse prevention, or overdose reversal, and serves the same medical function as the drug being substituted, if the substitution is consistent with clinical guidelines and peer-reviewed scientific and medical literature.(c) At least one version of each of the five medication-assisted treatment, relapse prevention, and overdose reversal prescription drugs listed in subdivision (a) shall not be subject to the following:(1) Prior authorization.(2) An annual or lifetime dollar limit, if federal restrictions on those limits are amended, revised, or repealed.(3) A requirement that the insured receives coverage at an outpatient facility that exceeds allowable time and distance standards for network adequacy, 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.(d) The requirements of this section shall not be subject to an insureds prior success or failure with medication-assisted treatment.(e) This section applies to an FDA-approved drug for use in medication-assisted treatment for opioid use disorder, relapse prevention, or overdose reversal that an insured is being prescribed as of January 1, 2019, or, for a new insured, that the new insured is being prescribed at the time of enrollment.(f) 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 opioid use disorder. Medication-assisted treatment includes, but is not limited to, pharmacologic therapies with or without 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 opioid use disorder.(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 opioid use disorder, and increase healthy life skills.(4) Financial requirements means a deductible, copayment, coinsurance, or out-of-pocket maximum.(g) This section does not restrict or impair the application of any other provision of this part.(h) This section shall remain in effect only until January 1, 2024, and as of that date is repealed. | |
| 123 | + | 10123.204. (a) A health insurer that provides prescription drug benefits shall cover, at a minimum, at least one version of each of the following medication-assisted treatment treatment, relapse prevention, and overdose reversal prescription drugs approved by the United States Food and Drug Administration (FDA) for opioid use disorder, regardless of whether a drug is self-administered or administered by a health care provider:(1) Buprenorphine.(2) Methadone.(3) Naltrexone.(4) A combination of buprenorphine and naloxone.(5) Naloxone in at least one form of administration approved for community use.(b) Each of the medications listed in subdivision (a) may be substituted for an equivalent drug that is approved by the FDA for medication-assisted treatment treatment, relapse prevention, or overdose reversal, and serves the same medical function as the drug being substituted. substituted, if the substitution is consistent with clinical guidelines and peer-reviewed scientific and medical literature.(c) Only At least one version of each of the five medication-assisted treatment treatment, relapse prevention, and overdose reversal prescription drugs listed in subdivision (a) and identified by a health insurer is not shall not be subject to the following:(1) Prior authorization.(2) An annual or lifetime dollar limit, if federal restrictions on those limits are amended, revised, or repealed.(3) A requirement that the insured receives coverage at an outpatient facility that exceeds allowable time and distance standards for network adequacy, 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. policies.(d) The requirements of this section shall not be subject to an insureds prior success or failure with the medication-assisted treatment services provided. treatment.(e) This section applies to an FDA-approved drug for use in medication-assisted treatment for opioid use disorder disorder, relapse prevention, or overdose reversal that an insured is being prescribed as of January 1, 2019, or, for a new insured, that the new insured is being prescribed at the time of enrollment.(f) 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 opioid use disorder. Medication-assisted treatment includes, but is not limited to, pharmacologic therapies with or without 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 opioid use disorder.(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 opioid use disorder, and increase healthy life skills.(4) Financial requirements means a deductible, copayment, coinsurance, or out-of-pocket maximum.(g) This section does not restrict or impair the application of any other provision of this part.(h) This section shall remain in effect only until January 1, 2024, and as of that date is repealed. | |
| 127 | 124 | ||
| 128 | 125 | ||
| 129 | 126 | ||
| 130 | - | 10123.204. (a) A health insurer that provides prescription drug benefits shall cover, at a minimum, at least one version of each of the following medication-assisted treatment, relapse prevention, and overdose reversal prescription drugs approved by the United States Food and Drug Administration (FDA) for opioid use disorder, regardless of whether a drug is self-administered or administered by a health care provider: | |
| 127 | + | 10123.204. (a) A health insurer that provides prescription drug benefits shall cover, at a minimum, at least one version of each of the following medication-assisted treatment treatment, relapse prevention, and overdose reversal prescription drugs approved by the United States Food and Drug Administration (FDA) for opioid use disorder, regardless of whether a drug is self-administered or administered by a health care provider: | |
| 131 | 128 | ||
| 132 | 129 | (1) Buprenorphine. | |
| 133 | 130 | ||
| 134 | 131 | (2) Methadone. | |
| 135 | 132 | ||
| 136 | 133 | (3) Naltrexone. | |
| 137 | 134 | ||
| 138 | 135 | (4) A combination of buprenorphine and naloxone. | |
| 139 | 136 | ||
| 140 | 137 | (5) Naloxone in at least one form of administration approved for community use. | |
| 141 | 138 | ||
| 142 | - | (b) Each of the medications listed in subdivision (a) may be substituted for an equivalent drug that is approved by the FDA for medication-assisted treatment, relapse prevention, or overdose reversal, and serves the same medical function as the drug being substituted, if the substitution is consistent with clinical guidelines and peer-reviewed scientific and medical literature. | |
| 139 | + | (b) Each of the medications listed in subdivision (a) may be substituted for an equivalent drug that is approved by the FDA for medication-assisted treatment treatment, relapse prevention, or overdose reversal, and serves the same medical function as the drug being substituted. substituted, if the substitution is consistent with clinical guidelines and peer-reviewed scientific and medical literature. | |
| 143 | 140 | ||
| 144 | - | (c) At least one version of each of the five medication-assisted treatment, relapse prevention, and overdose reversal prescription drugs listed in subdivision (a) shall not be subject to the following: | |
| 141 | + | (c) Only At least one version of each of the five medication-assisted treatment treatment, relapse prevention, and overdose reversal prescription drugs listed in subdivision (a) and identified by a health insurer is not shall not be subject to the following: | |
| 145 | 142 | ||
| 146 | 143 | (1) Prior authorization. | |
| 147 | 144 | ||
| 148 | 145 | (2) An annual or lifetime dollar limit, if federal restrictions on those limits are amended, revised, or repealed. | |
| 149 | 146 | ||
| 150 | 147 | (3) A requirement that the insured receives coverage at an outpatient facility that exceeds allowable time and distance standards for network adequacy, a specific number of visits, days of coverage, scope or duration of treatment, or other similar limitations. | |
| 151 | 148 | ||
| 152 | 149 | (4) Financial requirements different than those for other illnesses covered under the policy of health insurance. | |
| 153 | 150 | ||
| 154 | - | (5) Step therapy, fail first policies, or other similar drug utilization strategies or policies. | |
| 151 | + | (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. policies. | |
| 155 | 152 | ||
| 156 | - | (d) The requirements of this section shall not be subject to an insureds prior success or failure with medication-assisted treatment. | |
| 153 | + | (d) The requirements of this section shall not be subject to an insureds prior success or failure with the medication-assisted treatment services provided. treatment. | |
| 157 | 154 | ||
| 158 | - | (e) This section applies to an FDA-approved drug for use in medication-assisted treatment for opioid use disorder, relapse prevention, or overdose reversal that an insured is being prescribed as of January 1, 2019, or, for a new insured, that the new insured is being prescribed at the time of enrollment. | |
| 155 | + | (e) This section applies to an FDA-approved drug for use in medication-assisted treatment for opioid use disorder disorder, relapse prevention, or overdose reversal that an insured is being prescribed as of January 1, 2019, or, for a new insured, that the new insured is being prescribed at the time of enrollment. | |
| 159 | 156 | ||
| 160 | 157 | (f) For purposes of this section, the following definitions apply: | |
| 161 | 158 | ||
| 162 | 159 | (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 opioid use disorder. Medication-assisted treatment includes, but is not limited to, pharmacologic therapies with or without behavioral therapies. | |
| 163 | 160 | ||
| 164 | 161 | (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 opioid use disorder. | |
| 165 | 162 | ||
| 166 | 163 | (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 opioid use disorder, and increase healthy life skills. | |
| 167 | 164 | ||
| 168 | 165 | (4) Financial requirements means a deductible, copayment, coinsurance, or out-of-pocket maximum. | |
| 169 | 166 | ||
| 170 | 167 | (g) This section does not restrict or impair the application of any other provision of this part. | |
| 171 | 168 | ||
| 172 | 169 | (h) This section shall remain in effect only until January 1, 2024, and as of that date is repealed. | |
| 173 | 170 | ||
| 174 | 171 | 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. | |
| 175 | 172 | ||
| 176 | 173 | 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. | |
| 177 | 174 | ||
| 178 | 175 | 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. | |
| 179 | 176 | ||
| 180 | 177 | ### SEC. 3. |