Bill > S693

This bill addresses non-medical switching of prescription drugs by health insurance carriers, providing protections for patients who are currently stable on a specific medication. The bill defines non-medical switching as restrictive changes to a health plan's formulary that force patients to switch to a less costly alternate prescription drug. It requires health carriers to maintain coverage for a prescription drug if the patient is medically stable, the drug was previously approved, and the patient's healthcare professional prescribed it within the last six months. The bill establishes a detailed process for requesting coverage exemptions, mandating that health carriers respond to exemption requests within 72 hours (or 24 hours in urgent circumstances), and provides a clear appeals process if a coverage exemption is denied. Health carriers are prohibited from limiting prescription drug coverage through methods such as increasing cost-sharing, moving drugs to more restrictive tiers, or removing drugs from the formulary, with some exceptions for drug safety or discontinued medications. The bill applies to health benefit plans delivered or renewed in the state starting January 1, 2026, and covers multiple types of health insurance plans, including those regulated under different chapters of Massachusetts law. The goal is to protect patients from unexpected changes in their prescription drug coverage that could negatively impact their medical treatment.

Budget and Finance, Business and Industry, Health and Social Services

https://malegislature.gov/Bills/194/S693