- Reduce Prescription Drug Costs (H. 1133/S. 706, Representative Barber & Senator Lewis)
- Prescription drug prices are the leading factor in driving up health care costs across the system, impacting the budgets of individuals, families, employers and the state. An Act to ensure prescription drug cost transparency and affordability will: provide transparency around the underlying costs to produce prescription drugs; restrain abuses of pharmacy benefit managers (PBMs); authorize the Health Policy Commission to set upper payment limits for unreasonably high-priced drugs; require pharmacists to inform consumers if purchasing a drug at the retail price would be cheaper than using insurance; provide tools to strengthen MassHealth’s ability to negotiate lower drug prices; and support a permanent authorization and funding source for “academic detailing” to ensure doctors get accurate information to counter biased drug manufacturer marketing.
- Limit the wining and dining of doctors by drug marketing sales personnel: (S. 703, Senator Lewis)
- Research has shown that the provision of meals is effective in influencing a doctor’s prescribing practices. In 2008, HCFA was instrumental in passing a Massachusetts law that limits these promotional efforts to “modest meals.” However, under strong pressure from drug companies and the restaurant industry, the state’s regulatory definitions have loose restrictions on meals and permit alcoholic drinks at these educational programs. An Act to define modest meals and refreshments in prescriber education settings will put reasonable limits on meals and ban all alcohol in these settings.
Children’s Health Access
- Expand Health Coverage for Children (H. 162/S. 677, Representative D. Rogers & Senator DiDomenico)
- Currently, low-income immigrant children who are not otherwise eligible for MassHealth can access only very limited health coverage, which leaves them without adequate access to many services, including prescription drugs, mental health services, durable medical equipment, dental services, and emergency care. An Act to ensure equitable health coverage for children would expand MassHealth coverage to low-income children whose only barrier to accessing comprehensive coverage is their immigration status. Other states, including California, Washington, Oregon, Illinois and New York have already enacted this policy.
Dental Care Access
- Expand Access to Dental Care through Dental Therapists (H. 1916/S. 1215, Representatives Hogan and Pignatelli & Senator Chandler)
- The most vulnerable populations in Massachusetts often forgo their oral health needs due to the lack of easy access to a dentist. An Act to improve oral health for all Massachusetts residents authorizes an additional dental professional, called the dental therapist (DT), to work with a dentist to provide oral health care to more people. DTs present a critical opportunity for Massachusetts to close gaps in dental access for seniors, low-income families, children, and people with special needs.
- Restore Full MassHealth Dental Benefits (H. 1917/S. 1212, Representative Honan & Senator Chandler)
- An Act relative to the restoration of MassHealth adult dental benefits will restore full MassHealth dental benefits to more than 1 million individuals, including over 113,000 seniors and 230,000 people living with disabilities. Important dental services that are vital for good oral health and saving teeth are not currently covered by MassHealth. Left untreated, dental disease can lead to systemic infection, hospitalization, and the worsening of other medical conditions. Oral health is an integral part of overall health and should be included in health coverage.
Private Health Insurance
- Ensure Accuracy of Health Plan Provider Directories (H. 913/S. 610, Representative Barber & Senator Lewis)
- Accurate provider directories are critical to ensuring that health coverage works for consumers.
An Act to increase consumer transparency about insurance provider networks establishes a task force, chaired by the Division of Insurance, to make recommendations for regulations improving the accuracy of provider directories to ensure consistency across carriers. The bill also requires that provider directories be easily searchable, available to the public, and updated at least monthly.
- Protect Consumers from Surprise Out of Network Bills (H. 967, Representative Farley-Bouvier)
- Surprise billing occurs when patients receive out-of-network care that they did not or could not intentionally choose to receive, and then are faced with unexpected and unaffordable medical bills. An Act to protect consumers from surprise medical bills protects consumers by requiring health plans and providers to disclose comprehensive information to consumers about the network status of providers; requiring specific patient consent for out-of-network services; and prohibiting providers from billing consumers more than their in-network cost-sharing amount. Senator Welch filed legislation (S. 659, the PATIENT Act) that also includes provisions to protect consumers from surprise out-of-network billing.
Health Care Affordability