Sponsors (3)
The bill expands free access to lifesaving opioid overdose reversal drugs for Medicare, Medicaid, TRICARE beneficiaries and at-risk discharged patients to improve overdose safety, but it raises public and provider costs and risks uneven implementation and access.
Medicare, Medicaid, and TRICARE beneficiaries, plus patients discharged from hospitals/ERs/ambulatory surgical centers who are at risk of opioid overdose, will receive preventive opioid overdose reversal drugs at discharge or through their benefit with no copayment or deductible beginning Jan 1, 2026.
Eliminates patient cost-sharing (no copays or deductibles) for preventive opioid overdose reversal drugs across covered programs, reducing financial barriers for low-income and insured beneficiaries.
Including these drugs in Medicaid rebate and prescription categories may lower net costs to state programs and beneficiaries over time.
Federal and state programs (and thus taxpayers) will face increased drug spending beginning Jan 1, 2026, potentially raising Medicare and Medicaid outlays.
Requiring clinicians to determine who is 'at risk' and leaving furnishing voluntary may produce inconsistent access and inequities if providers apply criteria unevenly or if some hospitals decline to participate, leaving some at-risk patients without the benefit.
If manufacturers raise prices, and Medicare pays 100% of actual charges (subject to statutory caps), the program could face higher costs or payment disputes, increasing fiscal pressure.
Based on analysis of 2 sections of legislative text.
Requires Medicare, Medicare Advantage, and Medicaid to cover defined opioid overdose reversal drugs without cost-sharing when provided by clinicians at hospital/ED/ASC discharge, effective Jan 1, 2026.
Introduced September 3, 2025 by Brittany Pettersen · Last progress September 3, 2025
Requires Medicare (including Medicare Part B and Medicare Advantage) and Medicaid (including benchmark/benchmark-equivalent plans) to cover specified opioid overdose reversal drugs without any deductible, copayment, or other cost-sharing when furnished by clinicians in hospitals, emergency departments, or ambulatory surgical centers at discharge or departure for patients determined to be at risk, and adds the drugs into Medicaid drug coverage and rebate rules. The requirement takes effect January 1, 2026 and directs Medicare to pay the full allowed amount so beneficiaries owe nothing for these preventive opioid overdose reversal drugs.