summary
Introduced
01/22/2019
01/22/2019
In Committee
01/22/2019
01/22/2019
Crossed Over
Passed
Dead
12/31/2020
12/31/2020
Introduced Session
191st General Court
Bill Summary
Relative to changes to health benefit plans that cause certain covered persons to switch to less costly alternate prescription drugs. Financial Services.
AI Summary
This bill aims to prevent "nonmedical switching" by health benefit plans. Specifically, it prohibits health carriers, plans, or utilization review organizations from limiting or excluding coverage of a prescription drug for a covered person who is medically stable on that drug, as determined by their prescribing healthcare professional. The bill also establishes a process for covered persons to request a coverage exemption if their plan makes restrictive changes to the formulary, such as increasing cost-sharing or moving a drug to a more restrictive tier. Health carriers must respond to these requests within specified timeframes, and denials can be appealed. The bill applies to health benefit plans delivered, issued, continued, or renewed in Massachusetts on or after January 1, 2019.
Committee Categories
Business and Industry
Sponsors (4)
Last Action
Accompanied a study order, see H5160 (on 12/01/2020)
Official Document
bill text
bill summary
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bill summary
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bill summary
| Document Type | Source Location |
|---|---|
| State Bill Page | https://malegislature.gov/Bills/191/H949 |
| Bill | https://malegislature.gov/Bills/191/H949.pdf |
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