Healthcare

passed · Massachusetts · House Sep 18, 2025

H 1364: An Act relative to promoting healthcare access and affordability for patients

This bill requires health insurers and pharmacy benefit managers to pass at least 80% of estimated drug rebates directly to patients by reducing their out-of-pocket costs at the pharmacy, rather than keeping the savings. Insurers must report compliance annually to the state commissioner, with potential fines for non-compliance, while protecting rebate details as confidential business information. Additionally, it mandates a state analysis of barriers to accessing cell and gene therapies for MassHealth patients, including projected costs, reimbursement frameworks, and infrastructure needs through 2037, with specific focus on impacts on vulnerable populations.

Topics ✓ HealthcareSupports HealthcareBill explicitly promotes healthcare access and affordability, directly aligning with support indicators like improving patient access and funding initiatives.95% confidence

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in committee · Massachusetts · House Dec 4, 2025

H 4491: An Act relative to non-medical switching

This bill prevents health insurers from forcing patients to switch prescription drugs without medical necessity ("nonmedical switching"). It requires insurers to maintain coverage for drugs a patient is medically stable on (as determined by their doctor), unless the drug is removed due to FDA safety concerns or manufacturing issues. Insurers must provide a clear, fast-track process for patients to request coverage exemptions, responding within 72 hours (24 hours for emergencies), with automatic approval if they miss deadlines. The bill directly affects patients on stable prescription regimens and health insurers managing drug coverage under health benefit plans.

Topics ✓ HealthcareSupports HealthcarePrevents insurers from forcing unnecessary drug switches, requires coverage maintenance for stable patients, and mandates fast-track exemptions, protecting patient access and rights in prescription coverage.95% confidence

Sub-Topics Prescription Drugs

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in committee · Massachusetts · House Jun 17, 2026

H 4492: An Act relative to patient financial protection

This bill requires health insurance plans in Massachusetts covering prescription drugs to establish a separate out-of-pocket limit for those drugs - including specialty drugs - distinct from other medical costs. The limit cannot exceed the federal minimum annual deductible for high-deductible health plans (set under IRS code 26 U.S.C. §223), which covers both self-only and family coverage. It defines "out-of-pocket limit" to include cost-sharing expenses like copays under the Affordable Care Act. The rule applies to all relevant health insurance policies renewed or issued on or after January 1, 2026, directly affecting insurers and patients with prescription drug coverage.

Topics ✓ HealthcareSupports HealthcareRequires separate out-of-pocket limits for prescription drugs, capping patient costs to prevent excessive financial burden, aligning with patient protection in healthcare.95% confidence

Sub-Topics Prescription Drugs

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in committee · Massachusetts · House Aug 4, 2026

H 4493: An Act to ensure access to prescription medication and community pharmacies

This bill requires pharmacy benefit managers (insurance companies that manage drug benefits) to pay community pharmacies fairly for services, matching or exceeding Massachusetts Medicaid rates for both drug costs and dispensing fees. It prohibits "pharmacy steering" (directing prescriptions to pharmacies owned by the benefit manager) and mandates that all pharmacies, including community ones, can provide specialty medications if they meet standard service requirements. The bill also requires transparency in how drug costs are calculated and gives pharmacies a 7-day process to appeal underpayment claims. It directly affects community pharmacies, benefit managers, and patients seeking medication access, aiming to ensure equitable treatment for independent pharmacies.

Topics ✓ HealthcareSupports HealthcareRequires fair PBM payments to community pharmacies, prohibits steering, and ensures specialty medication access - improving patient access to prescriptions and protecting community pharmacy viability.95% confidence

Sub-Topics Prescription Drugs

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in committee · Massachusetts · House Jun 17, 2026

H 4494: An Act prohibiting PBMs from discriminating against hospitals and patients participating in the 340B drug discount program

This bill prohibits pharmacy benefit managers (PBMs) from discriminating against hospitals and clinics participating in the federal 340B drug discount program. It specifically bans PBMs from paying lower rates for 340B drugs than non-340B drugs, charging extra fees for 340B participation, restricting network access based on 340B status, or imposing higher patient costs (like extra copays) when using 340B providers. The law directly affects safety-net hospitals, clinics, and their patients who rely on the 340B program to access discounted medications. It ensures these providers aren’t penalized for participating in the federal program through PBM billing practices.

Topics ✓ HealthcareSupports HealthcareProhibits PBMs from discriminating against 340B hospitals/patients, preventing higher copays and ensuring lower drug costs for safety-net providers, directly improving access to affordable care.95% confidence

Sub-Topics Prescription Drugs

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passed · Massachusetts · Senate Mar 12, 2026

S 1563: An Act prioritizing patient access to care

By Ms. Kennedy, a petition (accompanied by bill, Senate, No. 1563) of Robyn K. Kennedy, Rebecca L. Rausch, Joanne M. Comerford, Susannah M. Whipps and other members of the General Court for legislation to prioritize patient access to care based upon the professional judgment of the physician.. Public Health.

Topics ✓ HealthcareSupports HealthcareBill prioritizes patient access to care based on physician judgment, directly improving healthcare access per support indicators.95% confidence

Sub-Topics Public Health

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passed · Massachusetts · House Sep 18, 2025

H 1133: An Act relative to patient financial protection

This bill requires most health insurance plans in Massachusetts to set a separate yearly maximum out-of-pocket limit specifically for prescription drugs (including specialty drugs). This limit cannot exceed the federal minimum annual deductible for high-deductible health plans (as defined in the Internal Revenue Code). It applies to all policies covering prescription drugs delivered, issued, or renewed after January 1, 2025, directly affecting patients who use prescription medications. The limit includes standard drug costs like copays and coinsurance, as defined under federal law.

Topics ✓ HealthcareSupports HealthcareBill establishes out-of-pocket limits for prescription drugs, reducing patient financial burden and protecting access to medications under insurance coverage.95% confidence

Sub-Topics Insurance

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passed · Massachusetts · Senate Dec 8, 2025

S 1409: An Act to reform mental health supports and increase public safety

This bill (SD 1718) requires mandatory psychiatric evaluations in hospital emergency rooms when a physician, psychologist, advanced practice nurse, or social worker authorizes a restraint for a patient. It directly affects individuals experiencing mental health crises who are placed under restraint in emergency settings. The key provision mandates that the emergency room, not other facilities, must determine whether to seek a 3-day hospitalization at a public or department-approved private facility. This change aims to standardize emergency mental health assessments and hospitalization decisions.

Topics ✓ Criminal JusticeSupports Criminal JusticeMandates psychiatric evaluations during ER restraints, diverting mental health crises from criminal justice system to appropriate care, aligning with reform goals.85% confidence ✓ HealthcareSupports HealthcareMandates psychiatric evaluations in ERs for restraint cases, directly strengthening mental health access and safety protocols within healthcare services.95% confidence

Sub-Topics Hospitals Mental Health Substance Abuse

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passed · Massachusetts · Senate Jan 7, 2026

S 1626: An Act to protect essential health services

S 1626, sponsored by Senator Bruce Tarr, aims to protect essential health services under Public Health legislation. The bill seeks to establish safeguards for critical healthcare services but lacks specific details in the provided abstract about which services or how protections would be implemented. Without additional context on its provisions or affected populations, this summary reflects only the bill's stated purpose as described in its title and abstract. The abstract does not specify mechanisms, affected groups, or concrete policy changes.

Topics ✓ HealthcareSupports HealthcareBill title explicitly aims to protect essential health services, directly aligning with support indicators like safeguarding critical care under public health legislation.95% confidence

Sub-Topics Public Health

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passed · Massachusetts · House Jan 28, 2026

H 1299: An Act to increase enrollment in affordable health plan networks

This bill (HD 3215) modifies Massachusetts health insurance regulations to increase enrollment in affordable health plan networks. It creates exemptions for insurance carriers if most members are in single-rate regions, subsidized coverage (Chapter 176Q), or if 80%+ income comes from government programs. The bill also requires carriers to include entire provider groups in networks on an "all-or-nothing" basis, rather than selectively adding providers to select or tiered networks. These changes primarily affect health insurance carriers operating in Massachusetts, aiming to simplify network requirements for certain plans and improve access to providers for enrollees.

Topics ✓ HealthcareSupports HealthcareBill explicitly aims to increase enrollment in affordable health plan networks, directly expanding access to healthcare coverage.95% confidence

Sub-Topics Insurance

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