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, 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.