Existing law sets forth various programs relating to opioid overdose prevention and treatment, including, among others, standing orders for the distribution of an opioid antagonist, a naloxone grant program, and a grant program to reduce fentanyl overdoses and use throughout the state.
Existing law establishes the Medi-Cal program, which is administered by the State Department of Health Care Services and 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. Under existing law, the pharmacist service of furnishing naloxone hydrochloride is a covered Medi-Cal benefit. The Medi-Cal program also covers certain medications to treat opioid use disorders as part of narcotic treatment program services, or as part of medication-assisted treatment services within the Drug Medi-Cal Treatment Program, as specified.
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.
This bill would make legislative findings relating to the United States Food and Drug Administration (FDA) approving a certain naloxone hydrochloride nasal spray for nonprescription use.
Under the bill, prescription or nonprescription naloxone hydrochloride or another drug approved by the FDA for the complete or partial reversal of an opioid overdose would be a covered benefit under the Medi-Cal program. The bill would require a health care service plan contract or health insurance policy that provides coverage for prescription drugs and that is issued, amended, delivered, or renewed on or after January 1, 2025, to cover prescription and nonprescription naloxone hydrochloride and all other drugs or products approved by the FDA for the complete or partial reversal of an opioid overdose. The bill would prohibit a health care service plan contract or health insurance policy that provides coverage for prescription drugs from imposing any cost-sharing requirements for that coverage exceeding $10 per package of medication, as specified, would require point-of-sale coverage for over-the-counter, FDA-approved naloxone hydrochloride or another FDA-approved drug or product for the complete or partial reversal of an opioid overdose at in-network pharmacies, and would prohibit a high deductible health plan from imposing cost sharing, as specified. The bill would repeal these provisions on January 1, 2030.
Because a willful violation of these 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.

Statutes affected:
02/15/23 - Introduced: 1797 HSC
03/16/23 - Amended Assembly: 1797 HSC
AB 1060: 1797 HSC