Bill > H982

This bill prohibits "nonmedical switching," which is when a health benefit plan makes restrictive changes to its formulary after the current plan year has begun or during the open enrollment period for the upcoming plan year, causing a covered person who is medically stable on their current prescribed drug to switch to a less costly alternate prescription drug. The bill requires health carriers, health benefit plans, and utilization review organizations to continue coverage for a covered person's prescription drug if the drug was previously approved, the person's prescribing healthcare professional has prescribed the drug within the previous six months, and the person remains enrolled in the plan. The bill also establishes a process for covered persons to request a coverage exemption determination if their plan makes changes that would require them to switch drugs, and requires timely responses to such requests. The bill applies to health benefit plans delivered, issued, continued, or renewed in Massachusetts on or after January 1, 2022 or January 1, 2025, depending on the specific insurance market.

Business and Industry, Health and Social Services

https://malegislature.gov/Bills/193/H982