Summary

Requires Medicare, Medicaid, TRICARE, and certain Medicaid alternative benefit plans to treat a defined “preventive opioid overdose reversal drug” (for example, naloxone) as a covered medical item when given to an inpatient or an emergency/ambulatory surgical patient at discharge or leave if the patient is at risk for overdose, and bans cost-sharing for that drug. The law directs the FDA Commissioner and HHS Secretary to issue guidance to state professional boards and hospitals about dispensing/distribution and billing within one year, clarifies that providers are not required to furnish the drug, and sets the coverage and cost-sharing rules to take effect for items furnished on or after January 1, 2026.

Key Points

• Creates a new covered category: 'preventive opioid overdose reversal drug' for Medicare, Medicaid, TRICARE, and certain Medicaid alternative plans.
• Requires coverage when the drug is furnished at discharge or leave to inpatients or emergency/ambulatory surgical patients at risk for overdose.
• Prohibits cost-sharing for these drugs when furnished under the specified conditions.
• Directs the FDA Commissioner and HHS Secretary to issue guidance to state professional boards and hospitals on dispensing and billing within one year.
• Clarifies providers are not required to furnish the drug, but coverage and payment rules apply if they do.
• Amends multiple federal statutes to align Medicare, Medicaid, and TRICARE rules with the new coverage category.
• Effective dates: short title on enactment; coverage and cost-sharing protections apply for items furnished on or after Jan 1, 2026.
• Likely increases hospital discharge access to opioid reversal drugs and removes cost barriers for covered patients.
• May impose additional costs or administrative requirements on state Medicaid programs and hospitals.

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