MA H4958

Mandates insurance coverage for opioid antagonists (e.g., naloxone) and opioid agonists/partial agonists (e.g., buprenorphine, methadone) used to treat opioid use disorder across all major insurance types in Massachusetts

Eliminates all cost-sharing requirements including deductibles, copayments, coinsurance, and out-of-pocket limits for these medications, with an exception for IRC-governed plans that would lose tax-exempt status

Removes prior authorization requirements and deems these medications automatically medically necessary; no prescription required for coverage

Applies to Group Insurance Commission plans (state employees), MassHealth/Medicaid, commercial insurers, HMOs, and hospital/medical service corporations

Prohibits health care facilities from balance billing patients; reimbursement rates for medical benefits capped at the carrier's average in-network pharmacy benefit rate