Bill > S694

This bill requires health insurance providers in Massachusetts to provide more transparent and accessible information about their prescription drug formularies, starting January 1, 2018. Specifically, insurance plans must notify enrollees about whether they use a formulary (a list of covered prescription drugs), explain how drugs are selected, and post their formularies online in a searchable, accessible format. Plans must update these online formularies within 72 hours of any changes and use a standard template developed by the Division of Insurance. The bill mandates that published formularies include detailed information such as prior authorization requirements, drug tiers with corresponding co-payments, cost-sharing details for drugs administered by providers, and a standardized range of out-of-pocket costs for each prescription drug. For drugs subject to coinsurance, plans must either disclose the exact dollar amount of cost-sharing or provide a cost range (e.g., under $100, $100-$250). Additionally, plans must explain how medications are included or excluded from deductibles and provide cost-sharing information for mail-order pharmacy options. These requirements apply to various types of health insurance plans, including individual and group plans, hospital service plans, medical service agreements, health maintenance contracts, and coverage for state employees.

Business and Industry, Health and Social Services

https://malegislature.gov/Bills/194/S694