CommercialCoverageMedium impact
Provider Alert: Prohibiting Copays at OTP Facilities
Healthfirst·NY · Psychiatry·Provider Update
Effective date
Jan 1, 2023
We identified it
Jun 20, 2026
Summary
Effective January 1, 2023, New York law prohibits commercial health insurance plans from charging copayments and coinsurance for services at Opioid Treatment Programs (OTP). Healthfirst is automatically reprocessing claims from January 1, 2023 onward to remove member cost sharing, and providers must refund any copays/coinsurance already collected from members for OTP services.
Action Required
Immediately: Providers must refund any copayments and coinsurance collected from members for OTP services rendered on or after January 1, 2023. Review Healthfirst reprocessed claims to verify removal of member cost share. Stop collecting copays/coinsurance for OTP services going forward - bill normally but do not apply member cost sharing.