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SENATE DOCKET, NO. 2180 FILED ON: 1/20/2023
SENATE . . . . . . . . . . . . . . No. 625
The Commonwealth of Massachusetts
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PRESENTED BY:
Sal N. DiDomenico
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To the Honorable Senate and House of Representatives of the Commonwealth of Massachusetts in General
Court assembled:
The undersigned legislators and/or citizens respectfully petition for the adoption of the accompanying bill:
An Act relative to out-of-pocket expenses for covid-19 therapeutics.
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PETITION OF:
NAME:DISTRICT/ADDRESS :Sal N. DiDomenicoMiddlesex and Suffolk 1 of 3
SENATE DOCKET, NO. 2180 FILED ON: 1/20/2023
SENATE . . . . . . . . . . . . . . No. 625
By Mr. DiDomenico, a petition (accompanied by bill, Senate, No. 625) of Sal N. DiDomenico
for legislation relative to out-of-pocket expenses for covid-19 therapeutics. Financial Services.
The Commonwealth of Massachusetts
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In the One Hundred and Ninety-Third General Court
(2023-2024)
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An Act relative to out-of-pocket expenses for covid-19 therapeutics.
Be it enacted by the Senate and House of Representatives in General Court assembled, and by the authority
of the same, as follows:
1 SECTION 1. Notwithstanding any other law, Sections 1-8 shall refer to a health care
2service plan contract issued, amended, or renewed on or after the operative date of this
3subdivision that covers medical, surgical, and hospital benefits, excluding a specialized health
4care service plan contract, with respect to therapeutics for COVID-19 covered under the contract,
5which shall include therapeutics approved or granted emergency use authorization by the federal
6Food and Drug Administration for treatment of COVID-19 when prescribed or furnished by a
7licensed health care provider acting within their scope of practice and the standard of care.
8 (a) A health care service plan contract that covers medical, surgical, and hospital
9benefits, excluding a specialized health care service plan contract, shall cover, without cost
10sharing and without prior authorization or other utilization management, the costs of therapeutics
11for COVID-19 covered under the contract, which shall include therapeutics approved or granted
12emergency use authorization by the federal Food and Drug Administration for treatment of 2 of 3
13COVID-19 when prescribed or furnished by a licensed health care provider acting within their
14scope of practice and the standard of care.
15 SECTION 2. A health care service plan shall reimburse a provider for the therapeutics
16described in paragraph (1) at the specifically negotiated rate for those therapeutics, if the plan
17and provider have negotiated a rate. If the plan does not have a negotiated rate with a provider,
18the plan may negotiate a rate with the provider.
19 SECTION 3. For an out-of-network provider with whom a health care service plan does
20not have a negotiated rate for the therapeutics described in paragraph (1), a health care service
21plan shall reimburse the provider for the therapeutics in an amount that is reasonable, as
22determined in comparison to prevailing market rates for the therapeutics in the geographic region
23in which the therapeutic was delivered. An out-of-network provider shall accept this payment as
24payment in full, shall not seek additional remuneration from an enrollee, and shall not report
25adverse information to a consumer credit reporting agency or commence civil action against the
26enrollee for therapeutics described in this subdivision.
27 SECTION 4. A health care service plan shall cover COVID-19 therapeutics without cost
28sharing, regardless of whether the therapeutics are provided by an in-network or out-of-network
29provider, and without utilization management. If a provider would have been entitled to receive
30cost sharing but for this section, the health care service plan shall reimburse the provider for the
31lost cost sharing. A provider shall accept this payment as payment in full, shall not seek
32additional remuneration from an enrollee, and shall not report adverse information to a consumer
33credit reporting agency or commence civil action against the enrollee for therapeutics pursuant to
34this subdivision. 3 of 3
35 SECTION 5. Beginning six months after the federal public health emergency expires, a
36health care service plan shall no longer be required to cover the cost sharing for COVID-19
37therapeutics delivered by an out-of-network provider, unless otherwise required by law.
38 SECTION 6. For purposes of this section, “health care service plan” includes a health
39plan service plan offered on the Massachusetts Health Connector that provides coverage for
40hospital, medical, surgical, or prescription drug benefits, excluding a specialized health insurance
41policy that provides coverage only for dental or vision benefits.
42 SECTION 7. For purposes of this section, “health care service plan” includes a
43MassHealth managed care plan that contracts with Massachusetts Department of Health and
44Human Services. MassHealth shall seek any federal approvals it deems necessary to implement
45this section. This section applies to a MassHealth managed care plan contract only to the extent
46that MassHealth obtains any necessary federal approvals, and federal financial participation
47under the Medicaid program is available and not otherwise jeopardized.
48 SECTION 8. This section applies to a disability insurance policy that provides coverage
49for hospital, medical, surgical, or prescription drug benefits, excluding a specialized health
50insurance policy that provides coverage only for dental or vision benefits.
51 (a)A disability insurance policy shall cover, without cost sharing and without prior
52authorization or other utilization management requirements, the costs of COVID-19 therapeutics
53approved or granted emergency use authorization by the federal Food and Drug Administration.