An Act relative to utilization review

This bill amends Massachusetts healthcare laws to restrict when insurance companies and utilization review organizations can require prior authorization for prescription drugs. It prohibits these entities from denying coverage for generic drugs, medications taken without interruption for six months, long-acting injectable antipsychotics, and FDA-approved treatments for opioid use disorders, among other specific scenarios. Additionally, the bill mandates that any adverse drug determination must be reviewed by a physician with relevant medical expertise and establishes a faster grievance process that automatically approves a drug if a decision is not made within 48 hours. These changes aim to streamline access to necessary medications and ensure that review decisions are made by qualified medical professionals.