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HD 3104

An Act preserving access to treatment for patients with serious mental illnesses

194th Legislature (2025-2026) Introduced by Rob Consalvo and 7 co-sponsors

Massachusetts bill restricts insurance denials of psychiatric medications and therapies to expand mental illness treatment access.

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Bill Summary · HD 3104

Legislative bill overview

HD 3104 aims to protect patient access to mental health treatments by restricting insurance companies' ability to deny or limit coverage for medications and therapies prescribed for serious mental illnesses. The bill establishes safeguards against prior authorization requirements and formulary restrictions that could delay or prevent patients from obtaining evidence-based psychiatric care.

Why is this important

Delays in mental health treatment can have serious consequences, including symptom deterioration, hospitalization, and suicide risk. Insurance coverage barriers disproportionately affect vulnerable populations already struggling with serious mental illness, making timely access to prescribed medications and therapies critical to patient outcomes and public health.

Potential points of contention

  • Cost implications: Insurance companies may argue that broad coverage mandates increase premiums for all policyholders, and insurers warn restrictions on prior authorization remove tools for controlling expensive specialty medications
  • Clinical autonomy vs. coverage management: Tension between protecting prescriber judgment and insurers' legitimate interest in preventing unnecessary treatments or promoting evidence-based formulary alternatives
  • Defining "serious mental illness": Disagreement over which conditions qualify for these protections and whether the definition is too broad or too narrow
  • Prior authorization burden: Debate over whether eliminating prior authorization entirely removes important safeguards or simply reduces bureaucratic delays for appropriate care

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

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