Fail-first therapy crackdown on move in Senate
Photo | Courtesy of Commonwealth of Massachusetts
Massachusetts State House
The Senate advanced seven pieces of legislation previously passed by the House on Monday morning, getting bills dealing with "fail first" insurance policies and the consequences of student loan debt default into the hopper for the final week of formal sessions.
Among the bills polled out was the Senate Ways and Means Committee's version of a step therapy bill (H 4929) that the House passed unanimously a month ago. Similar to the House version, the Senate bill appears put restrictions on -- but not totally ban -- the practice in which some patients are made to try and fail on insurance-preferred treatments before their insurer will approve a more expensive treatment prescribed by a doctor.
The Senate's bill, according to a Ways and Means Committee summary, would prohibit MassHealth, carriers or a utilization review board from "using clinical review criteria to establish a step therapy protocol that requires an insured to utilize a medication that is not likely to be clinically effective for the prescribed purpose" and directs the same entities to take into consideration the "needs of a typical patient populations and diagnoses when establishing clinical criteria to be used for step therapy protocol." It also would set out a process for patients to seek exceptions to directed step therapy protocols.
There appears to be at least one difference between the House and Senate versions: the Joint Committee on Health Care Financing reported that the House version would cost the state more than $100,000, but the Senate summary of the latest version says it would have no cost.
The bill has good odds of being in the mix as lawmakers send a flurry of legislation to Gov. Charlie Baker's desk in the days before the July 31 end of formal sessions -- the Senate unanimously passed a step therapy bill in July 2020 and the makeup of the branch has not changed significantly since then.
The Senate Ways and Means Committee also polled out a bill (H 4339) that the House passed in January which would prohibit state boards of registration and state agencies from denying, revoking or refusing to renew a professional or occupational certificate, registration, license or authority because of a person's default on an educational loan.
Other bills included in Monday morning's Senate Ways and Means poll would change the way MassHealth considers transfers of assets into a pooled trust by or for elder residents aged 65 or older if it is to pay for items or services not covered by MassHealth (H 4792), adjust some requirements related to municipal or regional school district procurements (H 596), and allow Lee and Lenox to convey land to the group that restores and maintains author Edith Wharton's home (H 4215).
While the Ways and Means Committee gave favorable reports (often with proposed amendments) to all seven bills Monday, committee poll voting breakdowns were not available early Monday afternoon. A Senate Ways and Means Committee spokesman did not return messages from the News Service seeking more information.
The Senate passed two bills that were part of the morning's Ways and Means Committee poll during its Monday informal session: one dealing with retirement system requirements (H 4338) and another related to the retirement system's alternative superannuation retirement benefit program (H 4443).
WBJ Web Partners
Most Recent
Most Recent
0 Comments