Bill
S 708
Prohibits insurers and MassHealth from using prior authorization, step therapy, or similar controls for FDA‑approved meds treating the defined serious mental illnesses.
Status snapshot
- Senate Docket No. 1148 / Senate Bill No. 708 (Presented by Sen. John J. Cronin).
- Introduced: Feb 25, 2025. Referred to committees (Financial Services; listed readings/hearings).
- Advanced to third reading and, on May 27, 2025, reported as substituted by A5445 (companion/house substitute).
- Bill text amends Massachusetts General Laws, Chapters 176O and 118E.
Purpose and intent
- To preserve and expedite patient access to FDA‑approved medications for a specified set of serious mental illnesses by prohibiting certain insurer and managed‑care protocols that delay or restrict dispensing of those drugs.
Key provisions
1. New statutory definition of “serious mental illness” (added to both Chapter 176O, §1 and Chapter 118E, §8), defined by the most recent DSM edition, and explicitly listing:
- Bipolar disorders (hypomanic, manic, depressive, mixed)
- Childhood and adolescent depression
- Major depressive disorder (single episode or recurrent)
- Obsessive‑compulsive disorders
- Paranoid personality disorder and other psychotic disorders
- Schizo‑affective disorders (bipolar or depressive)
- Schizophrenia
- Post‑traumatic stress disorder
Restrictions on utilization management (amendment to Chapter 176O, §12A):
Same prohibition applied to the Medicaid/Medicaid‑managed care context (amendment to Chapter 118E, §51A):
Who would be affected
- Primary beneficiaries: patients diagnosed with the listed serious mental illnesses who are prescribed FDA‑approved medications.
- Other affected parties: prescribing clinicians, pharmacies, health insurers and carriers, pharmacy benefit managers (PBMs), utilization review organizations, and the Commonwealth’s Medicaid program (MassHealth).
Potential impacts and considerations
- Access: Likely to reduce administrative barriers and delays for patients initiating or continuing FDA‑approved psychiatric medications, which proponents argue improves continuity of care and clinical outcomes.
- Cost and utilization: Removing prior authorization/step therapy could increase immediate drug utilization and short‑term spending for insurers and Medicaid; long‑term cost effects depend on clinical outcomes and substitution patterns.
- Oversight and fraud control: Prohibiting many utilization management tools may limit payer mechanisms for managing inappropriate use, verifying clinical necessity, or controlling costs; the bill does not specify alternative safeguards.
- Scope: Protections apply only to FDA‑approved drugs for the listed conditions; non‑drug treatments and drugs used off‑label are not expressly covered.
- Fiscal impact: Not specified in the bill; state and insurer fiscal effects would require budgetary analysis.
Procedural notes
- The bill text was substituted by A5445 on May 27, 2025 (check A5445 for the operative language and current status). A hearing was scheduled/rescheduled for Sept. 9, 2025 per the docket entries.
For further review
- See the text amendments to Chapter 176O (§1 and §12A) and Chapter 118E (§8 and §51A).
- Consult A5445 (substitute) and any fiscal notes or committee reports for detailed cost estimates and final legislative language.
Compiled from official sources — confirm details with the bill’s official record.
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