Bill > H4228

This bill amends the laws in Massachusetts to establish new requirements and processes related to step therapy protocols used by MassHealth (the state's Medicaid program) and private health insurance carriers. The key provisions include: 1. Requiring MassHealth and insurance carriers to grant exceptions to step therapy protocols in certain situations, such as if the required drug is contraindicated or expected to be ineffective for the patient. The exception process must meet federal requirements. 2. Defining "medically necessary" and "step therapy exception" to clarify the standards. 3. Requiring carriers to consider the needs of atypical patient populations and diagnoses when establishing step therapy protocols. 4. Establishing a process for patients and providers to request step therapy exceptions, with timelines for carrier responses. 5. Creating a state commission to study the implementation of these step therapy reforms and their impacts on costs, quality, and health disparities. The bill is intended to improve patient access to medications deemed appropriate by their healthcare providers, even when subject to step therapy protocols.

Budget and Finance

Joint Committee on Health Care Financing (J)

https://malegislature.gov/Bills/191/H4228