An Act relative to prescription medication re-authorization

194th Legislature (2025-2026) Introduced by Sally Kerans

Prohibits annual re-authorization of chronic-disease prescriptions by MA insurers, safeguarding uninterrupted access and adherence for patients and easing payer workflows.

Purpose and intent

The bill aims to ensure ongoing access to prescribed chronic-disease medications by prohibiting health insurers from requiring annual re-authorization for these drugs. The sponsor emphasizes preventing disruption of treatment for chronic conditions when patients are already prescribed medications by a licensed physician, physician’s assistant, or nurse practitioner.

Key provisions

Prohibition on annual re-authorizations: Any licensed health insurer subject to specified Massachusetts General Laws may not request or require an annual re-authorization for a prescription drug that has been duly prescribed for a chronic disease.

Scope of insurers: Applies to insurers regulated under chapters 32A, 118E, 175, 176A, 176B, or 176G of the General Laws.

Definition of eligible drugs: Applies to prescription drugs defined in section 1 of chapter 94C.

Prescriber eligibility: The bill covers drugs prescribed by a physician, physician’s assistant, or nurse practitioner for chronic diseases (examples listed include diabetes, heart disease, Alzheimer’s disease, cancer, stroke, respiratory disease).

Scope and definitions

Affected drugs: Prescription medications currently defined under MA law (chapter 94C).

Chronic diseases: Includes, but is not limited to, diabetes, heart disease, Alzheimer’s disease, cancer, stroke, and respiratory disease.

Health insurers: Entities regulated under the specified MA chapters (32A, 118E, 175, 176A, 176B, 176G).

Who is affected

Primary: Licensed health insurers operating in Massachusetts under the listed chapters.

Secondary: Patients with chronic diseases who rely on ongoing prescriptions, and their prescribing clinicians (physicians, PAs, NPs).

Potential indirect effects: Pharmacists and healthcare providers who coordinate ongoing medication management; payers’ administrative processes.

Procedural and timeline aspects

Status: Introduced and filed as a proposed bill (House Docket No. 1369). The current text indicates introduction/availability in the 2025-2026 session.

Effective date: The bill text does not specify an effective date or phased implementation; typical MA bills may require an effective date if enacted, followed by regulatory updates.

Related history: A similar measure was filed in a prior session (H. 3757 in 2023-2024), indicating ongoing legislative interest in preserving uninterrupted access to chronic-disease medications.

Potential impacts

Access and adherence: Expected to reduce interruptions in chronic-disease treatment caused by re-authorization requirements.

Administrative effects: Payers would need to adjust authorization workflows to remove annual re-authorization triggers for the covered drugs.

Fiscal considerations: The bill does not specify cost implications; potential changes in short-term administrative costs for insurers versus long-term savings from improved adherence and reduced gaps in care.

Notes: The bill’s language hinges on overriding existing authorizations processes for a defined subset of prescription drugs and insurers, with explicit emphasis on chronic-disease management.

Bill