Congress eliminates copays for opioid addiction treatment nationwide

What it does

This bill eliminates cost-sharing (copays, coinsurance, deductibles) for opioid addiction treatment under Medicare and private health insurance, and requires coverage of medication-assisted treatment, overdose reversal drugs, and recovery support services. It also tests a Medicare model in 15 high-need states and increases federal Medicaid funding to 90% for addiction treatment services.

Why we flagged it

The bill's core mechanism is a mandate to eliminate cost-sharing barriers and expand coverage for evidence-based opioid addiction treatment across Medicare and private insurance. This is a public health intervention designed to increase treatment access during the opioid crisis.

What the text implies

• The 15-state Medicare pilot may create geographic disparities in access if selected states do not represent all regions; beneficiaries in non-pilot states remain subject to cost-sharing.
• Elimination of cost-sharing may increase utilization and program costs; the bill does not specify budget offsets or payment rate adjustments to insurers.
• The definition of 'recovery support services' (peer counseling, transportation) is broad and may be interpreted differently by states and insurers, creating implementation variation.
• Private insurers may respond to zero-cost-sharing mandates by narrowing formularies, restricting provider networks, or increasing premiums on other services to offset losses.

Section numbers refer to the bill text the analysis read — linked under Primary records below.

Who it affects

The bill removes direct out-of-pocket costs for evidence-based opioid addiction treatment across Medicare and private insurance, lowering barriers to care for people struggling with opioid use disorder. Increased federal Medicaid funding and expanded coverage of recovery support services strengthen the public health response to the opioid crisis.

Who stands to gain

• Individuals with opioid use disorder (primary beneficiary — reduced out-of-pocket costs)
• Medication-assisted treatment providers and behavioral health clinics (increased patient volume, red
• Pharmaceutical manufacturers of opioid addiction medications (increased utilization)

Named in the bill

Centers for Medicare & Medicaid Services (CMS), Medicare Parts B, C, D, Medicaid, Health insurance issuers, Group health plans, Employee Retirement Income Security Act (ERISA), Public Health Service Act, Internal Revenue Code Chapter 100

Where it stands

• Sep 3, 2026 — Introduced · Congress.gov: “Introduced in House”
• Sep 3, 2026 — Referred to House Committee on Education and Workforce and House Committee on Ways and Means · Congress.gov: “Referred to the Committee on Energy and Commerce, and in addition to the Committees on Ways and Means, and…”

Dates and quoted wording are Congress.gov's action record; the timeline shows status changes, not every procedural step.