Massachusetts 2025-2026 Regular Session

Massachusetts House Bill H1155

Introduced
2/27/25  

Caption

Empowering health care consumers

Impact

The implications of HB 1155 are significant, as it sets a legal framework for health plans to follow, promoting greater accountability and consumer awareness. By requiring the disclosure of formulary information, the bill is expected to affect the way enrollees make informed choices about their healthcare options, potentially leading to better health outcomes and satisfaction among consumers. Additionally, it may incentivize health plans to offer more competitive pricing and coverage options, fostering a more consumer-centric healthcare environment in Massachusetts.

Summary

House Bill 1155, known as 'An Act empowering health care consumers', aims to enhance the transparency and accessibility of prescription drug formularies provided by health plans in Massachusetts. The bill mandates that any health insurance policy or agreement issued or renewed post-January 1, 2018, must notify enrollees if a formulary is in use. Furthermore, it outlines requirements for making this information accessible, such as posting the formulary details online and updating any changes within a 72-hour timeframe. Overall, the bill seeks to empower consumers by ensuring they have clear and timely information about the drugs covered and the costs involved.

Contention

While supporters of the bill argue that it is a necessary step towards consumer empowerment in healthcare, there may be points of contention regarding the administrative implications for health plans. Critics might raise concerns about the complexity of implementing the requirements for formulary disclosures and the potential for increased operational costs. Some stakeholders could also argue that it may create confusion among enrollees regarding tiered medication coverage and cost-sharing structures, which need careful management to ensure clarity.

Companion Bills

MA H4789

Replaced by Study Order

Previously Filed As

MA S694

Empowering health care consumers

MA H255

Relative to enabling access and empowering early educators

MA S374

Empowering students and schools to thrive

MA S909

Empowering patients and entrepreneurs with real transparency on cost

MA H954

Empowering vulnerable municipalities to protect residents and the environment from harmful pesticides

MA H4013

To improve healthcare and reduce consumer costs

MA S1471

Empowering municipalities and improving efficiency

MA H1930

Empowering student-athletes through NIL rights

MA H5321

Empowering municipalities and local governments

MA H1144

To protect health care consumers from surprise billing

Similar Bills

MA S694

Empowering health care consumers

ME LD1128

An Act to Modernize the Formulary for Naturopathic Doctors

AZ SB1102

Pharmacy benefits; prescribing; exemption

CA AB2000

Drug formularies.

MN HF1076

Pharmacy benefit managers and health carriers required to include lower-cost drugs in their formularies, and formulary structure and formulary tiering for each health plan required to give preference to the drug with the lowest out-of-pocket cost to the patient.

MN SF1876

Pharmacy benefit managers and health carriers inclusion of lower-cost drugs in formularies requirement provision and lowest out-of-pocket-cost drug to patient formulary tiering preference provision

FL H5015

State Group Insurance

MN HF4142

Medical assistance coverage of prescription drugs solely for weight loss prohibited.