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Bill > S561


MA S561

Empowering health care consumers


summary

Introduced
01/22/2019
In Committee
07/23/2020
Crossed Over
Passed
Dead
12/31/2020

Introduced Session

191st General Court

Bill Summary

For legislation to empower health care consumers. Financial Services.

AI Summary

This bill aims to empower health care consumers by requiring insurance plans to provide more transparent information about their drug formularies. Key provisions include: 1. Plans must provide clear notice to enrollees about whether they use a formulary, how drugs are included/excluded, and how often the formulary is reviewed. 2. Plans must post their full formularies online in a searchable format and update them within 72 hours of any changes. 3. Plans must use a standardized template developed by the Division of Insurance to display their formularies. 4. Formularies must disclose any prior authorization, step therapy, or utilization management requirements for each drug. 5. For tiered formularies, plans must specify the tier and copay amount for each drug. 6. For drugs covered under the medical benefit, plans must disclose all covered drugs and the dollar cost-sharing. 7. For drugs subject to coinsurance, plans must either disclose the exact dollar amount or provide a cost-sharing range. The overall goal is to give consumers and providers clearer and more timely information about a plan's drug coverage to help them make more informed health care decisions.

Committee Categories

Business and Industry, Health and Social Services

Sponsors (12)

Last Action

Ought NOT to pass (under Joint Rule 10) and placed in the Orders of the Day for the next session (on 07/23/2020)

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