Bill > H941

This bill aims to restrict healthcare carriers and the Massachusetts Medicaid program (MassHealth) from performing prior authorization and retrospective review in certain circumstances. Specifically, it prohibits prior authorization for generic prescription drugs not listed as controlled substances, prescription drugs not listed as controlled substances after 6 months of use, therapeutic duplicates already approved, dosage adjustments, long-acting injectable antipsychotics, and medications approved for opioid use disorder treatment. It also requires adverse determinations during prior authorization to be reviewed by a physician in the same specialty as the prescriber or one focused on the relevant condition. Additionally, the bill creates an expedited internal grievance process for adverse prior authorization determinations if the prescriber believes the patient will suffer serious harm without the medication.

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https://malegislature.gov/Bills/193/H941