Sec. 7. Limitations on cost-sharing for opioid overdose reversal medications

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Subpart II of part A of title XXVII of the Public Health Service Act ( 42 U.S.C. 300gg–11 et seq.), as amended by section 6, is further amended by adding at the end the following: A group health plan (other than a self-insured plan) or a health insurance issuer offering group or individual health insurance coverage shall not impose any cost-sharing requirement under the plan or coverage with respect to at least one brand or generic version of opioid overdose reversal drug. In this section, the term opioid overdose reversal drug means a drug or biological approved by the Food and Drug Administration for— complete or partial reversal of opioid depression, including respiratory depression, induced by opioids; or emergency treatment of a known or suspected opioid overdose, as manifested by respiratory or central nervous system depression. .

Section 1860D–2(b) of the Social Security Act ( 42 U.S.C. 1395w–102(b) ) is amended— in paragraph (1)(A), by striking The coverage and inserting Subject to paragraph (8), the coverage ; in paragraph (2)(A), by striking and

(D)and inserting and

(D)and paragraph

(8); in paragraph (3)(A), by striking and

(4)and inserting (4), and

(8); in paragraph (4)(A)(i), by striking The coverage and inserting Subject to paragraph (8), the coverage ; and by adding at the end the following new paragraph: For plan year 2021 and each subsequent plan year, each prescription drug plan and MA–PD plan shall not impose any cost-sharing requirement under the plan with respect to at least one brand or generic version of an opioid overdose reversal drug (as defined in section 2729B of the Public Health Service Act). The requirement under the preceding sentence shall also apply to cost-sharing applicable to subsidy eligible individuals under section 1814D–14. For purposes of subparagraph (A), the elimination of cost-sharing shall include the following: The waiver of the deductible under paragraph (1). The waiver of coinsurance under paragraph (2). The initial coverage limit under paragraph

(3)shall not apply. The waiver of cost-sharing under paragraph (4). . Section 1860D–14(a) of the Social Security Act ( 42 U.S.C. 1395w–114(a) ) is amended— in paragraph (1), in the matter preceding subparagraph (A), by striking In the case and inserting Subject to section 1860D–2(b)(8), in the case ; and in paragraph (2), in the matter preceding subparagraph (A), by striking In the case and inserting Subject to section 1860D–2(b)(8), in the case .

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42 USC 300gg–11
42 USC 1395w–102(b)
42 USC 1395w–114(a)

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cites case law

Sec. 7

Limitations on cost-sharing for opioid overdose reversal medications

Cite42 USC 300gg–11

Cite42 USC 1395w–102(b)

Cite42 USC 1395w–114(a)

Cites 3Cited by 0 across 0 sources