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H 1379

An Act exempting medications used for the treatment of opioid use disorder from the prior approval process under the Massachusetts Medicaid program

194th Legislature (2025-2026) Introduced by Mike Kushmerek

MassHealth medications for opioid use disorder would be exempt from prior authorization and step-therapy requirements, speeding access to treatment.

Bill reported favorably by committee and referred to the committee on House Ways and Means
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Bill Summary · H 1379

Summary of H 1379: Exemption of Opioid Use Disorder Medications from Prior Authorization in MassHealth

What the bill would do

  • Purpose: Amend Massachusetts law to exempt medications used for the treatment of opioid use disorder (OUD) from the MassHealth prior authorization and step-therapy requirements.
  • Legal change: Section 51A of Chapter 118E (Massachusetts General Laws) would be amended by replacing the current definition of “Step Therapy Protocol” with a new definition. The new text clarifies that while utilization management policies and prior authorization generally apply to prescription drugs, those requirements shall not apply to any medications prescribed for the treatment of opioid use disorder.

Specifically, the bill states that:
- A “Step Therapy Protocol” is a utilization management policy/program establishing the sequence in which a prescription drug is covered.
- The provision that governs prior authorization and utilization management does not apply to medications prescribed for the treatment of opioid use disorder.

Key provisions and changes

  • Scope: Applies to medications prescribed for the treatment of opioid use disorder within the MassHealth program (Massachusetts Medicaid).
  • Protection from utilization management: No step-therapy requirements or prior authorization regulations would apply to OUD medications, effectively streamlining access for patients undergoing treatment for OUD.

Who is affected

  • MassHealth beneficiaries receiving medications for opioid use disorder.
  • Healthcare providers who prescribe OUD treatments (e.g., medications used in MAT).
  • MassHealth and contracted entities responsible for managing prescription benefits, including any private plan sponsors under MassHealth.

Procedural and timeline details

  • Introduced: February 27, 2025 (House Docket No. 1947; Rep. Kushmerek).
  • Committee action: Referred to the Joint Committee on Health Care Financing on February 27, 2025; hearing scheduled for July 1, 2025 (Gardner Auditorium) as part of prevailing committee process.
  • Status updates:
    • Senate concurrence noted.
    • Reporting date extended: The bill’s reporting date extended to Wednesday, March 18, 2026.
  • Related/replace bills: HD 1947 is identified as replacing this measure.

Additional context

  • This bill does not specify new funding or budgetary allocations; it focuses on regulatory/administrative access by removing prior authorization barriers for OUD medications within MassHealth.
  • The broader policy goal is to reduce treatment delays and barriers to evidence-based OUD medications, aligning coverage with clinical best practices for addiction treatment.

Next steps

  • If advanced and enacted, the amendment would become law, applying to MassHealth medication coverage for OUD treatments and removing prior authorization requirements for these drugs. Stakeholders should monitor the March 18, 2026 reporting date and any subsequent committee reports or floor actions.

Compiled from official sources — confirm details with the bill’s official record.

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