HOUSE DOCKET, NO. 3227        FILED ON: 1/18/2019

HOUSE  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  No. 3556

The Commonwealth of Massachusetts

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PRESENTED BY:

Sean Garballey and John J. Lawn, Jr.

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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 promoting continuity of care for multiple sclerosis treatment.

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PETITION OF:

HOUSE DOCKET, NO. 3227        FILED ON: 1/18/2019

HOUSE  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  No. 3556

The Commonwealth of Massachusetts

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In the One Hundred and Ninety-First General Court
(2019-2020)

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An Act promoting continuity of care for multiple sclerosis treatment.

Be it enacted by the Senate and House of Representatives in General Court assembled, and by the authority of the same, as follows:
 

SECTION 1. Chapter 32A of the General Laws, as appearing in the 2016 Official Edition, is hereby amended by adding the following new section:-

Section 28. The commission shall provide to any active or retired employee of the commonwealth and who is insured under the group insurance commission coverage for a disease modifying prescription drug for treatment of multiple sclerosis that the individual has already been prescribed and has already been taking.  This section shall also require coverage for such an ongoing disease-modifying prescription drug treatment under any non-group policy.

SECTION 2. Chapter 175 of the General Laws, as appearing in the 2016 Official Edition, is hereby amended by inserting after Section 47II the following new section:-

Section 47JJ. Any policy of accident and sickness insurance as described in section 108 that provides hospital expense and surgical expense insurance and that is delivered, issued or subsequently renewed by agreement between the insurer and policyholder in the commonwealth; any blanket or general policy of insurance described in subdivision (A), (C) or (D) of section 110 that provides hospital expense and surgical expense insurance and that is delivered, issued or subsequently renewed by agreement between the insurer and the policyholder, within or without the commonwealth ; or any employees’ health and welfare fund that provides hospital expense and surgical expense benefits and that is delivered, issued or renewed to any person or group of persons in the commonwealth, shall provide to a commonwealth resident covered by the policy, coverage for a disease-modifying prescription drug to treat multiple sclerosis that the individual has already been prescribed and has already been taking, upon receipt of documentation by the prescribing provider that 1) the member has been diagnosed with a form of multiple sclerosis, and 2) the member has been stabilized or has achieved a positive clinical response as evidenced by low disease activity or improvement in symptoms on the drug.

The benefits in this section shall not be subject to any greater deductible, coinsurance, copayments or out-of-pocket limits than the maximum deductible, coinsurance, copayments or out-of-pocket limits for other disease-modifying prescription drugs for multiple sclerosis covered by the policy.  This section shall also require coverage for such an ongoing disease-modifying prescription drug treatment for multiple sclerosis under any non-group policy.

SECTION 3. Chapter 176A of the General Laws, as appearing in the 2016 Official Edition, is hereby amended by inserting after Section 8KK the following new section:-

Section 8LL. Any contract between a subscriber and the corporation under an individual or group  hospital service plan that is delivered, issued or renewed in the commonwealth shall provide as  benefits to any individual subscribers or members within the commonwealth a disease-modifying  prescription drug to treat multiple sclerosis that the individual has already been prescribed and has already been taking, upon receipt of documentation by the prescribing provider that 1) the member has been diagnosed with a form of multiple sclerosis, and 2) the member has been stabilized or has achieved a positive clinical response as evidenced by low disease activity or improvement in symptoms on the drug.

The benefits in this section shall not be subject to greater deductible, coinsurance, copayments or out-of-pocket limits than the maximum deductible, coinsurance, copayments or out-of-pocket limits for other disease-modifying prescription drugs for multiple sclerosis covered by the policy.  This section shall also require coverage for such an ongoing disease-modifying prescription drug treatment for multiple sclerosis under any non-group policy.

SECTION 4. Chapter 176B of the General Laws, as appearing in the 2016 Official Edition, is hereby amended by inserting after Section 4KK the following new section:-

Section 4LL. Any subscription certificate under an individual or group medical service agreement that shall be delivered, issued or renewed within the commonwealth shall provide as benefits to any individual subscriber or member within the commonwealth coverage for a disease-modifying prescription drug to treat multiple sclerosis that the individual has already been prescribed and has already been taking, upon receipt of documentation by the prescribing provider that 1) the member has been diagnosed with a form of multiple sclerosis, and 2) the member has been stabilized or has achieved a positive clinical response as evidenced by low disease activity or improvement in symptoms on the drug.

The benefits in this section shall not be subject to any greater deductible, coinsurance, copayments or out-of-pocket limits than the maximum deductible, coinsurance, copayments or out-of-pocket limits for other disease-modifying prescription drugs for multiple sclerosis covered by the policy.  This section shall also require coverage for such an ongoing disease-modifying prescription drug treatment for multiple sclerosis under any non-group policy.

SECTION 5. Chapter 176G of the General Laws, as appearing in the 2016 Official Edition,  is hereby amended by inserting after Section 4CC the following new section:-

Section 4DD.  An individual or group health maintenance contract shall provide coverage and benefits to any individual within the commonwealth for a disease-modifying prescription drug for treatment of multiple sclerosis that the individual has already been prescribed and has already been taking, upon receipt of documentation by the prescribing provider that 1) the member has been diagnosed with a form of multiple sclerosis, and 2) the member has been stabilized or has achieved a positive clinical response as evidenced by low disease activity or improvement in symptoms on the drug.

The benefits in this section shall not be subject to any greater deductible, coinsurance, copayments or out-of-pocket limits than the maximum deductible, coinsurance, copayments or out-of-pocket limits for other disease-modifying prescription drugs for multiple sclerosis covered by the policy.  This section shall also require coverage for such an ongoing disease-modifying prescription drug treatment for multiple sclerosis under any non-group policy.