Bill > S2433

This bill aims to improve patient safety and access to necessary medications by regulating the use of step therapy protocols by MassHealth, managed care organizations, and utilization review organizations. Some key provisions: 1. It establishes criteria for when a step therapy exception must be granted, such as when the required drug is likely to cause harm or is expected to be ineffective for the patient. It requires prompt review and approval of exception requests. 2. It mandates that clinical review criteria for step therapy protocols cannot require use of a medication that is not likely to be clinically effective based on evidence. 3. It creates a commission to study the impact of step therapy reforms on total medical expenses, health care quality, premiums, and patient out-of-pocket costs, as well as any effects on health disparities. 4. The bill applies to health benefit plans issued or renewed in Massachusetts on or after January 1, 2021.

Budget and Finance

Joint Committee on Health Care Financing (J)

https://malegislature.gov/Bills/191/S2433