Today's Law As Amended


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AB-2384 Medication-assisted treatment.(2017-2018)



As Amends the Law Today


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(2) An annual or lifetime dollar limit, if federal restrictions on those limits are amended, revised, or repealed.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 enrollee’s 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 patient’s 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 insured’s 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 patient’s 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 XIII B 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 XIII B of the California Constitution.