Bill
S 728
Requires parity for infertility coverage and bans step-therapy across Massachusetts public and private plans, enabling IVF/related care without prior-required alternatives.
Note on source material
- The materials provided contain conflicting and mixed content (different titles, unrelated New Jersey language, and multiple sponsor lists). The operative Massachusetts bill text in this packet is titled “An Act relative to step therapy and in vitro fertilization insurance coverage,” filed by Senator William J. Driscoll, Jr. The summary below describes that Massachusetts bill text. Verify the official legislative website for any amendments, final text, committee reports, or corrected metadata.
Purpose and intent
- Require insurance coverage parity for diagnosis and treatment of infertility across multiple types of coverage in Massachusetts, and prohibit insurers from imposing step‑therapy mandates that force patients to try other medications or procedures before receiving the physician‑recommended treatment.
Key provisions (by statutory placement)
1. Chapter 32A (Section 17S) — Group Insurance Commission
- Requires benefits offered by the Group Insurance Commission for active and retired Commonwealth employees to include coverage for medically necessary expenses of infertility diagnosis and treatment “to the same extent that benefits are provided for other pregnancy‑related procedures.”
- Prohibits requiring a patient to take a medication or undergo a procedure prior to or instead of the medication/procedure recommended by the patient’s physician (i.e., bans step‑therapy requirements for infertility care).
- Defines “infertility” as inability to conceive during 1 year if female ≤35, or 6 months if female >35; time spent attempting to conceive before a pregnancy that did not result in live birth counts toward the period.
Chapter 118E (Section 10O) — MassHealth / Medicaid and contracted plans
Chapter 175 (Section 47H), Chapter 176A (Section 8K), Chapter 176B (Section 4J) — Commercial, HMO, and medical service contracts
Who is affected
- State employees and retirees covered by the Group Insurance Commission.
- MassHealth/Medicaid beneficiaries and enrollees in Medicaid managed care, ACOs, and primary care clinician plans.
- Commercial insurance policyholders, HMOs, and medical service plan subscribers in Massachusetts where infertility coverage is provided.
- Insurers, HMOs, third‑party administrators and plan contractors operating in Massachusetts.
Potential impacts
- Increased access to infertility diagnosis and treatments, including IVF and related services, by removing insurer step‑therapy hurdles.
- Administrative changes for insurers to eliminate prior “step” requirements for infertility care; potential increases in utilization of higher‑level fertility interventions.
- Possible actuarial and premium effects for insurers and public programs (not specified in the bill — no cost estimates or explicit benefit limits included).
- No effective date or enforcement mechanism beyond insertion into the cited statutes is specified in the provided text.
Legislative status (from provided materials)
- Introduced Feb 25, 2025; referred to committee (materials show “REFERRED TO MENTAL HEALTH” but other entries list Financial Services). Multiple hearing/committee entries in the packet appear inconsistent. Consult the Massachusetts legislature’s official docket for current status and next steps.
Compiled from official sources — confirm details with the bill’s official record.
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