Massachusetts Senate Bill S693

Massachusetts 2025-2026 Regular Session

• Introduced: 2/27/25
• Refer: 2/27/25

Caption

Relative to non-medical switching

Impact

If enacted, this legislation will modify existing statutes to ensure that patients who have been prescribed a medication remain eligible for coverage even when health plans decide to change their formularies. It tackles the issue of continuity of care, ensuring that those stabilized on a given prescription will have access to that medication without burdensome restrictions or abrupt changes. This is particularly relevant in the context of chronic conditions where consistent medication is crucial for health management.

Summary

Bill S693, also known as the Act Relative to Non-Medical Switching, seeks to regulate the practices of health benefit plans regarding changes to formulary lists that may require covered individuals to switch to less expensive prescription drugs. Specifically, this bill is designed to protect patients who are medically stable on a prescribed medication by prohibiting health carriers from restricting or excluding coverage for specific drugs without clear justification. These practices are referred to as non-medical switching, and the bill aims to prevent it from impacting patients negatively during their treatment journey.

Contention

There are points of contention surrounding Bill S693, particularly regarding its potential implications for health carriers. Advocates argue that it provides necessary protections for patients against arbitrary changes that might affect their treatment. Conversely, opponents may argue that it could lead to increased costs for health plans, as they may be unable to implement cost-saving measures that involve switching patients to less expensive alternatives. The debate around this bill centers on balancing patient care and health plan operational flexibility.