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Adds a new subsection (nnn) defining 'preventive opioid overdose reversal drug' and adds subparagraph (KK) to 1861(s)(2) to include such drugs furnished on or after January 1, 2026.
Amends subsection (a)(1) cross-references and subsection (b) to add an exclusion (numbered as (14)) stating that the deductible shall not apply with respect to a preventive opioid overdose reversal drug (as defined in section 1861(nnn)) furnished on or after January 1, 2026.
Amends section 1902(a)(10)(A) by inserting a reference to a new paragraph (32), thereby requiring State plans to include preventive opioid overdose reversal drugs as part of covered benefits beginning January 1, 2026.
Amends section 1905(a) by inserting a new paragraph (32) to list preventive opioid overdose reversal drugs described in section 1861(nnn) as medical assistance beginning January 1, 2026.
Amends subsection (a)(2) and (b)(2) to add new subparagraph (K) exempting preventive opioid overdose reversal drugs (as defined in section 1861(nnn)) from deduction, cost sharing, or similar charges beginning January 1, 2026; also adds related clause in 1916A(b)(3)(B) to apply the prohibition to alternative cost sharing.
This bill would make overdose-reversal medicines for opioids available at no cost to people who are at risk and are leaving a hospital, emergency room, or ambulatory surgery center. A doctor, nurse practitioner, physician assistant, or other approved clinical staff could give the medicine at discharge, along with simple use instructions. The medicine can be a nasal spray or an injection. This only applies when the clinician decides the person is at risk for an overdose.
Starting January 1, 2026, Medicare and Medicare Advantage must cover these drugs with no deductibles or co-pays. Medicaid must also cover them without cost-sharing, including for people in alternative benefit plans. TRICARE will not charge co-pays for these drugs either. Within a year of the law taking effect, the FDA will issue guidance to state pharmacy, nursing, and medical boards to help hospitals safely give out these medicines and remove barriers. The federal health agency will also guide hospitals on billing. Providers are not forced to hand out the medicine; this just makes coverage and guidance clear.
Key points
Referred to the Committee on Energy and Commerce, and in addition to the Committees on Ways and Means, and Armed Services, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
Introduced September 3, 2025 by Brittany Pettersen · Last progress September 3, 2025