An Act relative to prescription-drug utilization review

This bill amends Massachusetts insurance laws to restrict when health plans can require prior authorization for prescription drugs, specifically banning it for generic non-controlled medications, drugs taken continuously for six months, and certain long-acting injectable antipsychotics. It also limits retrospective reviews of already-paid claims unless there is credible evidence of fraud or if the treatment exceeded the originally approved scope. Additionally, the legislation mandates that any adverse decision on a drug request must be reviewed by a physician in the same specialty as the prescribing doctor and establishes a faster grievance process that automatically approves the drug if the insurer does not respond within 48 hours.