HANDS Act Naloxone Access

Summary#

This bill (the HANDS Act) adds a new coverage category for "preventive opioid overdose reversal drugs" and requires no-cost coverage in several federal health programs. The bill defines a preventive opioid overdose reversal drug as an intranasal or intramuscular opioid overdose reversal medicine given by a physician, nurse practitioner, physician assistant, or other attending clinical personnel to a hospital inpatient, emergency department patient, ambulatory surgical center patient, or certain hospital patients when the clinician determines the person is at risk for an opioid overdose. The drug must be given at the time the person is discharged or leaves the emergency department and include instructions for use. The rule takes effect January 1, 2026.

Under Medicare, the bill adds these drugs to the list of covered items and prohibits beneficiary cost sharing for them; Medicare payment is set at 100 percent of the lesser of actual charges or an amount determined under existing law. Medicare Advantage plans are also prohibited from charging cost sharing for these drugs. Under Medicaid, the bill requires states to include preventive opioid overdose reversal drugs in medical assistance and in alternative benefit plans without any deduction or cost sharing beginning January 1, 2026, and applies existing rebate rules to these drugs. TRICARE is amended so eligible beneficiaries will not have to pay cost sharing for these drugs beginning January 1, 2026.

The bill also requires the FDA to issue guidance within one year for State boards of pharmacy, nursing, and medicine on safe hospital-based dispensing and removing barriers. The Department of Health and Human Services must issue guidance within one year for hospitals on billing for these preventive drugs. The bill clarifies that it does not require any specific provider to actually give a preventive opioid overdose reversal drug.

What it means for you#

  • If you are a patient who a clinician determines is at risk of opioid overdose and you are leaving a hospital, emergency department, or ambulatory surgical center, you may be offered an intranasal or intramuscular overdose reversal drug at no cost starting January 1, 2026.
  • If you have Medicare, Medicaid, or TRICARE, the bill says you should not pay cost sharing for this preventive drug when it is furnished as described.
  • Clinicians and hospitals will get federal guidance on how to dispense and bill for these drugs, but the law does not force providers to give the drug to anyone.

Expenses#

  • The bill removes cost sharing for beneficiaries in Medicare (including Medicare Advantage), Medicaid, and TRICARE for preventive opioid overdose reversal drugs furnished as described.
  • For Medicare, the bill specifies payment: Medicare would pay 100 percent of the lesser of the actual charge or an amount determined under existing Medicare rules.
  • For Medicaid, states must cover these drugs as medical assistance and include them in alternative benefit plans without cost sharing; existing Medicaid drug rebate rules will apply to these products.
  • No publicly available information about the bill’s total budgetary cost or estimates is included in the bill text or provided metadata.

Proponents' View#

No publicly available information.

Opponents' View#

No publicly available information.