HD 2059 requires Massachusetts health insurance plans to cover medications for opioid use disorder (like naloxone and buprenorphine) without prior authorization, prescriptions, or cost-sharing (deductibles, copays). It directly affects Commonwealth employees (via group insurance), Medicaid patients, and private insurance holders in Massachusetts. The bill mandates coverage as both a medical benefit (when administered at treatment facilities) and pharmacy benefit, with facilities reimbursed at standard rates to prevent balance billing. It also specifies that cost-sharing may still apply if a plan would lose tax-exempt status under IRS rules.
By Representative Ryan of Boston, a petition (accompanied by bill, House, No. 1404) of Daniel J. Ryan for legislation to establish integrated electronic health records. Health Care Financing.
This bill (HD 2860) extends prior authorization periods for community-based long-term care services to up to five years for MassHealth members with chronic conditions. It directly affects MassHealth members with persistent health conditions (including intellectual/developmental disabilities) requiring services like Adult Day Health, Home Health Aide, or Adult Foster Care. The key provision replaces shorter, recurring authorizations with multi-year approvals, while allowing modifications if a member's condition changes. This reduces administrative burdens for members and providers, ensuring uninterrupted access to necessary care under defined service plans.
By Representative Plouffe of Brockton, a petition (accompanied by bill, House, No. 1402) of Bridget Plouffe for legislation to establish criteria for MassHealth hardship waivers. Health Care Financing.
This bill prevents hospitals and healthcare providers from denying medically necessary care due to unpaid medical debt. It requires these facilities to publicly post their medical debt collection policies online and bans collection tactics like robocalls, threatening to withhold care, or failing to inform debtors about legal options. Consumers who successfully defend against medical debt lawsuits can recover reasonable attorney fees. The law specifically defines medical debt as a distinct category for collection purposes and updates debt collection regulations to prioritize patient access to care.
By Representative Lawn of Watertown, a petition (accompanied by bill, House, No. 419) of John J. Lawn, Jr., and James C. Arena-DeRosa relative to alleviating the burden of medical debt for patients and families. Consumer Protection and Professional Licensure.
By Mr. O'Connor, a petition (accompanied by bill, Senate, No. 2053) of Patrick M. O'Connor for legislation to establish a tax credit for individuals paying for home health care and hospice. Revenue.
This bill protects 340B providers - like community health centers and safety-net hospitals that participate in the federal 340B drug discount program - from unfair practices by pharmacy benefit managers (PBMs). It prohibits PBMs from reimbursing these providers at lower rates than non-340B entities, charging extra fees for 340B participation, restricting network access based on 340B status, or requiring special drug identifiers. The bill also bans PBMs from imposing higher patient copays or steering patients away from 340B providers. These changes ensure 340B providers can operate fairly and patients can access discounted medications without additional barriers.
This bill establishes licensing requirements for specialty pharmacies in Massachusetts that dispense specialty medications. It requires these pharmacies to designate a registered pharmacist in charge who must maintain good standing with their licensing board, submit annual reports, and keep detailed records of all drugs dispensed. The law also prohibits out-of-state pharmacies from dispensing specialty medications in Massachusetts without obtaining a specialty license. Additionally, it mandates that insurance carriers cannot block access to specialty drugs dispensed by licensed pharmacies that meet required handling and monitoring standards.
H 4496 requires health insurance plans covering prescriptions to allow partial medication fills at a pro-rated daily cost when a doctor or pharmacist determines it benefits the patient and the patient agrees. It prohibits insurers from denying coverage for partial fills used to synchronize multiple prescriptions (e.g., aligning refill dates for several medications). The bill also mandates full payment for dispensing fees on partial fills and blocks insurers from using pro-rated dispensing fees. This directly affects patients needing medication synchronization, pharmacists, prescribers, and health insurance plans in Massachusetts.
