Bill > S1235

This bill aims to address step therapy protocols and patient safety. It establishes a commission to study and assess the implementation of step therapy process reforms, including their impact on total medical expenses, healthcare quality outcomes, and health disparities. The bill also sets requirements for clinical review criteria used to establish step therapy protocols, and creates a process for patients and providers to request step therapy exceptions. The exceptions can be granted if the required drug is contraindicated, expected to be ineffective, or not in the patient's best interest based on medical necessity. The bill applies these provisions to both commercial health plans and the Medicaid program in Massachusetts.

Health and Social Services

https://malegislature.gov/Bills/191/S1235