Massachusetts 2025-2026 Regular Session

Massachusetts Senate Bill S694

Introduced
2/27/25  
Refer
2/27/25  

Caption

Empowering health care consumers

Impact

With the passage of S694, state laws relating to health insurance disclosure will be updated to require that formularies are not only posted on insurance providers' websites but also be actively updated within 72 hours of any change. This measure is intended to facilitate easier access for consumers to pertinent information, which can assist them in making informed choices regarding their health care and prescriptions. The Division of Insurance is tasked with developing a standard template to ensure consistency across all health care service plans in conveying this critical information.

Summary

S694, titled 'An Act Empowering Health Care Consumers', aims to enhance transparency in health insurance plans regarding the utilization of formularies for prescription drugs. The bill mandates that health insurance providers must notify enrollees in their coverage documents whether their plan employs a formulary. If a formulary is used, it must include comprehensive details on its structure, such as how drugs are included or excluded, and the frequency with which the formulary is reviewed. This change represents a significant step towards ensuring consumers are well-informed about their health coverage options.

Contention

While proponents of S694 argue that it bolsters consumer rights by improving access to information, some industry advocates express concerns about the administrative burden it places on insurers. There is apprehension that the mandate for rapid updates to formularies could lead to increased operational costs that may be passed on to consumers. Furthermore, the requirements for detailed disclosures might overwhelm individuals unfamiliar with insurance language, potentially diluting the intended benefits of transparency.

Companion Bills

MA S2931

Replaced by Order relative to authorizing the joint committee on Health Care Financing to make an investigation and study of certain current Senate documents relative to to health care financing matters.

Previously Filed As

MA H1155

Empowering health care consumers

MA S695

Promoting consumer choice in health care

MA S2931

Order relative to authorizing the joint committee on Health Care Financing to make an investigation and study of certain current Senate documents relative to to health care financing matters.

MA S698

Relative to consumer deductibles

MA S374

Empowering students and schools to thrive

MA S692

To facilitate timely access to quality health care by expanding access to patient navigation

MA S691

Ensuring access to healthcare and medically necessary food for children

MA S909

Empowering patients and entrepreneurs with real transparency on cost

MA H255

Relative to enabling access and empowering early educators

MA S2972

Order relative to authorizing the Joint Committee on Health Care Financing to make an investigation and study of certain current Senate documents relative to health care financing matters.

Similar Bills

MA H1155

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 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

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.

FL H5015

State Group Insurance

FL H0899

Insurer Disclosures on Prescription Drug Coverage