Overview
- New regulations would remove pre-approvals for emergency and urgent care, primary care, chronic disease management, physical and occupational therapy, reproductive and maternity care, substance use treatment, and certain prescription drugs.
- The policy applies to every insurer operating in Massachusetts, with regulations to be filed this week and a public comment period before they take effect.
- Patients managing chronic conditions, such as diabetes, would no longer need prior approvals for related services, devices, or medications, including insulin and pumps.
- Healey launched a Health Care Affordability Working Group led by Kate Walsh and Lisa Murray, with proposals sought by June.
- Insurers argue prior authorization controls costs, while officials point to delays and administrative burden, citing a CAQH $1.3 billion estimate for 2023 and a Milliman analysis warning spending could rise if approvals end.