Section 12B: Commission on step therapy protocol; responsibilities; annual report
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/ma/part-i/title-xxii/chapter-176o/12b·A research copy — for the controlling text, always check the official state or federal source. Not legal advice.
Section 12B.
(a)There shall be a commission on step therapy protocols within the division. The commission shall consist of: the commissioner of insurance or a designee, who shall serve as chair; the executive director of the health policy commission or a designee; the assistant secretary for MassHealth or a designee; the executive director of the center for health information and analysis or a designee; and 7 members appointed by the governor, 1 of whom shall represent the Massachusetts Public Health Association, 1 of whom shall represent Blue Cross and Blue Shield of Massachusetts, Inc., 1 of whom shall represent the Massachusetts Association of Health Plans, Inc., 1 of whom shall represent a patient advocacy organization, 1 of whom shall represent an employer organization, 1 of whom shall be currently practicing as a licensed physician in the commonwealth and 1 of whom shall be currently practicing as a licensed clinician, other than a physician, who has prescribing authority under the scope of their licensure. The commission shall meet as needed to satisfy the reporting requirements of this section.
(b)The commission shall study and assess the implementation of step therapy process reforms established in section 51A of chapter 118E and section 12A. The commission shall:
(i)analyze the impact of step therapy protocols on total medical expenses, health care quality outcomes, premium cost and out-of-pocket costs to the consumer and the health care cost benchmark; and
(ii)assess the efficacy of the step therapy exception process in ensuring that consumers diagnosed with medical conditions that rely on stability or have achieved a positive clinical response on a medication are able to maintain that course of treatment including, but not limited to, a form of multiple sclerosis. The commission shall also examine any available empirical data on the impact of step therapy protocols on health disparities related to outcomes, access and medication adherence.
(c)Not later than October 1 of each even-numbered year, the commission shall submit a report that includes findings from the commission's review and recommendations, including any draft legislation necessary to implement the recommendations, to the secretary of health and human services and the joint committee on health care financing.