4 August, 2020
Senate Passes Bill to Limit the Use of Step Therapy
Today, the Massachusetts State Senate passed legislation to limit the use of step therapy, or ‘fail-first’ protocols that too often direct patients to cheaper medications rather than those more suitable to treat their condition, The bill, An Act relative to step therapy and patient safety, gives health care providers more leverage in determining the most effective treatment options for patients, saving patients expensive and painful regimens on medications they know to be ineffective or harmful.
This bill builds on the Senate’s ongoing commitment to creating a more affordable, accessible, and patient-centered health care system for all. The Senate has already passed legislation this session to address rising prescription drug prices, increase access to mental health services, protect patients and enhance quality care. The step therapy legislation expands on this progress.
“From the outset of the session, the Senate has prioritized life-saving patient reforms that will improve treatment outcomes for all residents,” stated Senate President Karen E. Spilka (D-Ashland). “I am proud to add limiting the use of step therapy to our long list of health care accomplishments as it will help shift the balance of care back in the direction of the patient. I want to thank Senators Cyr and Friedman for elevating this important issue.”
“Providing the right treatment and therapies at the right time to people with cancer and debilitating diseases is all too important and critical during this extremely challenging time as is ensuring the wellbeing of patients in need,” said Senator Michael J. Rodrigues (D-Westport), Chair of the Senate Committee on Ways and Means. “With the passage of this bill today, the Senate is taking a vital step forward to providing guardrails around the use of step therapy and ensuring patient safety. I applaud Senate President Spilka for her continued leadership, Senator Cyr, Senator Friedman and others for their hard work and advocacy to move this critical legislation forward that puts patients first.”
"Patients with complicated illnesses should be receiving the medications that their doctors know they need—not repeatedly taking medications that they know to be ineffective just to help insurers save on costs," said State Senator Julian Cyr (D-Truro), Chair of the Joint Committee on Mental Health, Substance Abuse, and Recovery, who sponsored the legislation. "Step therapy is a shortsighted practice that puts patients at unnecessary risk; it takes lower costs today in exchange for more harm, more hospitalizations, and more spending in the very near future. I’m proud that the Senate took action to arrest this practice in Massachusetts."
“This bill takes an important step toward placing treatment decisions back in the hands of the health care provider and patient by limiting opportunities for insurance companies to force a patient to fail on certain medications before they can access the one most suitable for their needs,” said Senator Cindy F. Friedman (D-Arlington), co-chair of the Joint Committee on Health Care Financing. “While we must continue to address the high cost of drugs, we cannot do it at the expense of patients, and cost can never be the primary determinant of whether a patient has to suffer needlessly before they can access the medication that is most effective for treating their condition.”
"Too often, patients whose symptoms leave them weak and fatigued find that the regimen of medicine that they need is withheld and they instead are put on a path of pharmaceuticals which are at best less expensive but at worst ineffective in overcoming their illness. This so-called fail-first then try again approach leaves people and their families feeling desperate and uncared for," said Senate Minority Leader Bruce Tarr (R - Gloucester).
Step therapy serves as a cost-saving mechanism that can limit a patient’s ability to access the medication that is most suitable for treating their condition. Insurers that utilize step therapy protocols require medical providers to prescribe lower-cost medications to patients first, and only grant approval for alternative medications when the cheaper options have failed to improve a patient's condition. In practice, this results in insurers effectively choosing medications for the patient, even in cases where their providers have recommended an alternative. When patients change insurers, they are often forced to start at the beginning of the step therapy protocol again, which results in wasteful health care expenditures, lost time for patients, and potentially devastating health care impacts on the patient.
Step therapy is not limited to specific disease states. It affects patients across the healthcare spectrum, with particularly dramatic impacts on the Allergy and Asthma, Antipsychotic, Arthritis, Cancer, Coronary Artery, Depression, Diabetes, HIV/AIDS, Multiple Sclerosis, and Parkinson’s patient communities.
As such, the bill would establish guardrails to protect patients in circumstances in which following step therapy protocols are counterproductive or harmful. It would require MassHealth and private insurers to grant exemptions to step therapy protocols in cases where the protocol-required cost-effective drug is likely to cause harm, is expected to be ineffective, has been tried by the patient previously, is not in the best interest of the patient, or adopting it in concert with the patient's existing medications would cause harm. Upon granting exemptions, MassHealth and private insurers would be required to provide coverage for the drug recommended by the patient's provider.
The bill would provide patients subject to step therapy sequences with an accessible exception request process whenever coverage is restricted. The legislation establishes enumerates specific timelines for insurers to review requests and grant exceptions, and in cases where interruptions in the patient's medication schedule puts them at considerable risk, the turnaround time is faster. If an exception to step therapy is denied, the decision can be appealed.
In addition, the bill takes several steps to enhance transparency. Under the bill, insurers would be required to file annual reports to the Division of Insurance (DOI) detailing the number of step therapy exception requests received, the number of requests denied, and the reasons for denial. This additional data is expected to keep insurers from chronically denying exception requests or making deceptive cases for keeping patients adhered to step protocols when they have requested otherwise.
The bill would also commit DOI resources to overseeing the implementation of step therapy reforms, with particular attention to cost-effectiveness and continuum of care for patients requesting exceptions. The DOI would be required to deliver biannual reports to the Massachusetts Secretary of Health and Human Services and the Joint Committee on Health Care Financing.
If passed, Massachusetts would join 28 other states in curbing unfair step therapy practices. The bill, An Act relative to step therapy and patient safety, now moves to the House of Representatives for consideration.
SENATE PASSES GENOCIDE EDUCATION BILL
The Massachusetts State Senate on Thursday, July 30, 2020, passed An Act concerning genocide education to educate middle and high school students on the history of genocide and to promote the teaching of human rights issues.
“To forge a more just future, our next generation must be educated on the tragic history of the Holocaust and other instances of genocide,” stated Senate President Karen E. Spilka (D-Ashland). “The importance of this bill cannot be overstated, and I say this as a Jewish woman and the daughter of a World War II veteran who helped liberate the victims of Nazi concentration camps. I am very thankful to Senators Rodrigues, Lewis and Creem for their advocacy on this issue and my colleagues for their unanimous support.”
“Seventy-five years after the liberation of the Auschwitz-Birkenau Nazi death camp, we, as a society, continue to grapple with the root causes of hatred and discrimination. With the passage of this bill today, we take a critically important step to ensuring our students are educated on the Holocaust, the grave mistakes of the past, and stand ready to root out the injustices of the future,” said Senator Michael J. Rodrigues (D-Westport), Chair of the Senate Committee on Ways and Means. “As the forces of fake news, division, and ignorance continue to march on, I applaud Senate President Spilka and my colleagues in the Senate for standing up to say that we will never forget the lessons of the past. I also thank my constituent, Dr. Ron Weisberger, and the advocates for their urgent efforts to ensure we use the power of education to address hate, broaden public awareness, and shape our collective future.”
According to a 2018 article in the New York Times, 31% of Americans and 41% of millennials believe 2 million Jews or fewer were murdered in the Holocaust while 41% of Americans and 66% of millennials do not know what Auschwitz is. This bill would establish a Genocide Education Trust Fund to promote and educate middle and high school students on the history of genocide. Funds in this trust would be used to encourage the instruction of middle and high school students on the history of genocide and ensure the development of curricular materials, as well as to provide professional development training to assist educators in the teaching of genocide.
“It is shocking how many young people today have never heard of the Auschwitz concentration camp, the Holocaust, or other heinous genocides perpetrated in the past,” said Senator Jason Lewis (D-Winchester), Senate Chair of the Joint Committee on Education. “This important legislation will ensure that more students understand the history of genocide so that it never happens again. I’m grateful to Senator Rodrigues for championing this legislation and to all of the educators and advocates who have worked to see this bill passed.”
“Students need to be educated about the causes of genocide if we are to ensure that history is not repeated,” said Majority Leader Senator Cynthia Stone Creem (D-Newton). “Learning about the paths that various societies and cultures have taken—from bigotry and hatred all the way to expulsion and genocide—will help future generations avoid this tragedy.”
“As the granddaughter of a Holocaust survivor, genocide education legislation is personal for me,” said Senator Becca Rausch (D – Needham). “We are in a difficult moment in this country, as our nation and our Commonwealth grapple with significant upticks in blatant demonstrations of hate. Hate leads to devastation and destruction. We combat hate and ignorance with education and meaningful dialogue. I am proud and grateful that the Senate passed the genocide education bill today, and particularly grateful to Senator Rodrigues for his leadership and compassion.”
“We congratulate Senate President Spilka, Senate Ways and Means Chair Rodrigues, and our partners in government for coming together to ensure that students in our state will learn invaluable lessons about the consequences of hate and bigotry, from the most painful parts of our history,” said Aaron Agulnek, Director of Government Affairs for the Jewish Community Relations Council. “We cannot simply say ‘Never Again’ if we do not also commit to educating the next generation by giving them the resources they need to recognize and stand up to injustice before it takes root.”
"We appreciate the leadership of Senate President Spilka, Senate Ways and Means Chair Rodrigues, and their legislative colleagues for taking a critical step toward ensuring that Massachusetts public school students receive Holocaust and genocide education prior to high school graduation,” said Robert Trestan, ADL New England Regional Director. “The need for Holocaust and genocide education in K-12 schools could not be more urgent. Massachusetts now has an opportunity to use the power of education to address hate through this essential initiative for Holocaust and genocide education in the Commonwealth.”
The bill requires each school district to annually file a description of their lesson plan and programs related to genocide education with the Department of Elementary and Secondary Education (DESE). The bill also establishes a competitive grant program that schools and districts can apply to for additional programming support.
An Act concerning genocide education now moves to the Massachusetts House of Representatives for consideration.
Senate Advances Maternal Health Package
The Massachusetts State Senate on Thursday, July 30, 2020, unanimously passed three bipartisan bills to increase birth options and safety for all pregnant and perinatal people in the Commonwealth of Massachusetts. One bill establishes a commission to study barriers to substance use treatment for women in the perinatal period, another establishes a commission to address racial inequities in maternal healthcare in Massachusetts, and a third increases options for safe, professional birthing care in the Commonwealth by licensing midwifery.
“At a time when inequities in our health care system are being highlighted by a global pandemic, I am proud to support these critical bills to support maternal health,” stated Senate Karen E. Spilka (D-Ashland). “This package is about turning the tide on the tragic imbalance in treatment and outcomes that exists in maternal health, particularly in our Black and brown communities, and ensuring all pregnant people and new mothers have access to the care they need. The Senate has remained laser-focused this session on breaking down barriers, enhancing transparency and lowering the cost of health care and will continue to push for reforms to make our health care system better. I’d like to express my gratitude to Senators Joan Lovely and Becca Rausch for their efforts. This is an example of what we can and should accomplish by having women in positions to make change.”
An Act relative to improving access to treatment for individuals with perinatal substance use disorder creates a special commission to study the barriers to substance use treatment for women in the perinatal period. This commission will bring together the Department of Mental Health (DMH), the Department of Public Health (DPH), the Department of Children and Families (DCF), MassHealth, the Bureau of Substance Abuse Services, and private partners with expertise in maternal mental health and substance use treatment to ensure pregnant and postpartum women with substance use disorder have meaningful access to the care they need.
This commission will evaluate how different factors like insurance coverage, access to family-based treatment, screening for perinatal substance use disorder, and the integration of perinatal care and substance use treatment affect the availability of care. The commission will also recommendations to provide greater access to treatment for this vulnerable population.
“New mothers are one of the most at-risk populations for opioid overdose in the Commonwealth. Over the last decade, the proportion of pregnancy-associated deaths related to substance use has increased sharply. More than a third of pregnancy-related deaths in Massachusetts are fatal opioid overdoses,” said Senator Joan B. Lovely (D-Salem), the lead sponsor of the perinatal substance abuse bill and Chair of the Senate Committee on Rules, which ushered through two of the bills. “This special commission will identify and recommend ways to address the barriers to care for women during the perinatal period, when many already struggle with isolation, depression, and anxiety. This legislation represents a key step toward providing more, better treatment options to give new mothers confidence to seek and receive care while parenting their children.”
An Act to reduce racial disparities in maternal health establishes a commission to address the continuing racial inequities in the Commonwealth’s maternal health outcomes, specifically in cases of maternal mortality and morbidity. Among the developed nations of the world, only the U.S. continues to allow people giving birth to die in increasing numbers, and the outcomes are staggeringly worse for people of color, who experienced a 238% increase in the risk of maternal death between 1978 and 2015.
The commission will bring together diverse perspectives on maternal health and racial health disparities and will include public health experts, physicians, midwives, a doula, and individuals with first-hand experience with health disparities, including a survivor of maternal morbidity. The bill requires that a majority of commission members represent Massachusetts communities most impacted by maternal health inequity, which statistically have been Black and brown communities. The commission must submit a report of its findings and recommendations, including any draft legislation necessary to achieve the recommendations of the commission, within one year of its creation.
“People giving birth now are more likely to suffer injury, illness, or death than our mothers and grandmothers who delivered in the previous century, and Black and brown birthing people are more than twice as likely to be forced to endure those heartbreaking harms,” said Senator Becca Rausch (D-Needham), the lead sponsor of the maternal health disparities and midwifery bills. “We cannot allow that to stand, nor can we tackle a problem without understanding the full extent of its impact. The maternal health disparities commission we establish today will serve as that meaningful first step in crafting policy solutions to the tangible racial disparities in maternal health outcomes in Massachusetts. I am grateful to Senate President Karen Spilka, Senate Rules Committee Chair Joan Lovely, my House co-filers Representatives Liz Miranda and Kay Khan, and the many advocates whose collaboration made this commission possible.”
In response to this bill, Dr. Amutah-Onkagha, an Associate Professor at Tufts University School of Medicine and the organizer of the Annual Black Maternal Health Conference said, “Massachusetts is a national leader in healthcare for many reasons and the passage of the Senate bill to develop a maternal health commission that addresses disparities in maternal health outcomes for Black women is no different. As a Black woman, maternal health advocate and public health professor, I am encouraged by the work that the commission will accomplish to improve the health of women across the Commonwealth by reducing maternal mortality and morbidity. I am particularly excited that the voices, expertise and strength of Black women will lead and shape the timely and urgent work that the commission will achieve.”
An Act relative to out-of-hospital birth access and safety creates licensure for certified professional midwives who provide home birth services, which are less expensive than hospital-based birth and associated with healthy birth outcomes, including lower rates of Caesarean section and fewer postpartum complications. This credentialing process will standardize midwifery training and qualifications, provide consumers with transparent information when seeking a home birth, and facilitate the hospital transfer process in the event of labor compilations. In addition to making home birth midwifery care more accessible for birthing people, the bill also reduces potential barriers to entry into the profession. Two members of the licensing board must come from populations historically underrepresented in the profession, and the legislation includes licensing fee waivers for aspiring low-income midwives.
The demand for home birth midwifery care has increased sharply during the coronavirus crisis. The licensure provided by this legislation secures healthcare worker status for professional midwives, yielding access to personal protective equipment and other supports necessary for Massachusetts midwives to safely deliver pre- and post-natal care.
Senator Rausch said, “The midwives bill increases health care access, improves health outcomes, and reduces health costs, all at once. I’m proud to have championed this critical reproductive justice legislation in the Senate and grateful that Massachusetts is now a significant step closer to joining the 36 other states in the nation that provide licensure for certified professional midwives. The import of this bill was undeniable before the pandemic hit, and COVID-19 laid bare its urgency, as increasing numbers of birthing people throughout the Commonwealth seek home birth midwifery care to avoid exposure to the virus and to keep from taxing the hospital-based healthcare system unnecessarily. Thank you to Senate President Karen Spilka, Senate Ways and Means Chair Michael Rodrigues, my House co-filer Representative Kay Khan, and the many advocates who collaborated with me to bring this bill to the Senate floor for its passage.”
On this bill, Ann Whitman, a Certified Professional Midwife who practices in Massachusetts said, "I've been a Certified Professional Midwife in Massachusetts for almost thirty years, and we've always worked toward licensure, but practicing through this pandemic has exposed the need for safe and accessible out-of-hospital birth like never before. I've been receiving at least ten times the amount of inquiries from families hoping that a home birth is an option, but Massachusetts is so far behind the majority of other states, completely lacking a framework for equitable access to home birth, or minimum standards and protocols for practice. Massachusetts families need this bill passed."
An Act relative to improving access to treatment for individuals with perinatal substance use disorder, An Act relative to out-of-hospital birth access and safety and An Act to reduce racial disparities in maternal health now move to the Massachusetts House of Representatives for consideration.
Senate Passes Bill to Increase Reporting Requirements for Department of Children and Families
The State Senate today passed a bill to introduce new oversight and reporting requirements for the Massachusetts Department of Children and Families (DCF). An Act relative to accountability for vulnerable children and families also moves the child fatality review board to the Office of the Child Advocate (OCA), establishes a ‘Foster Parent Bill of Rights,’ and increases access to mental health care for children in the Commonwealth.
“As a former Chair of Children, Families and Persons with Disabilities, ensuring the safety and well-being of the Commonwealth’s children remains deeply and personally important to me,” stated Senate President Karen E. Spilka (D-Ashland). “I’d like to thank everyone who contributed to the strength of this bill by looking at the needs of our children from a holistic point of view. I’d like to particularly thank Senator Chang-Diaz and Senator Rodrigues for ensuring this bill moved forward.”
“This bill represents an important step towards increased accountability in the child welfare system,” stated Senator Sonia Chang-Diaz (D-Boston), co-chair of the Joint Committee on Children, Families and Persons with Disabilities. “While we must continue to push for improved data collection on racial disparities and LGBTQ+ youth, this legislation will strengthen transparency and increase support for system-involved children and families.”
Under the bill, DCF would be required to publish consolidated annual reports and quarterly profiles, establish a 3-year plan with targets for safety, permanence and well-being outcomes for children, and submit a report on young adults who continue to receive services after reaching the age of 18. The bill also updates reporting requirements that are outdated, irrelevant or duplicative, and requires DCF and the Department of Elementary and Secondary Education to develop clear plans for maintaining close contact with, and providing quality education to, children who have open cases with DCF during the COVID-19 state of emergency.
“This bill will protect some of the most vulnerable children in the Commonwealth while strengthening our foster system and providing support for foster parents,” said Senator Michael Rodrigues (D - Westport), Chair of the Senate Committee on Ways and Means. “Thank you to Senate President Spilka for her leadership, Senators Chang-Diaz and Comerford for their work on this legislation, and all of my Senate colleagues for championing foster families.”
“The mission of the DCF is vital and the Senate has consistently adopted bipartisan supported legislation to strengthen the agency so that the people who are tasked with protecting these vulnerable children have standards of accountability that maximize the well-being and safety of those they serve,” said Senate Minority Leader Bruce Tarr (R- Gloucester). “Importantly, this bill advances those goals in a timely and effective way.”
To increase access to vital mental health care for children in care, the bill eliminates prior authorization for mental health acute treatment for children experiencing acute mental health crises. It also requires emergency departments to have the capacity to evaluate and stabilize a person admitted with a mental health presentation at all times, and to refer them to appropriate treatment or inpatient admission, expediting the process for individuals under 22 years old. Additionally, the bill establishes a pilot program, administered by the Department of Public Health, to increase student access to tele-behavioral health services in schools.
“This bill is an important step in maintaining the health and well-being of vulnerable children in our Commonwealth, particularly during this time of increased anxiety and need,” said Senator Cindy F. Friedman (D-Arlington), Chair of the Joint Committee on Health Care Financing. “I’m pleased that this bill reduces barriers to mental health care for children and increases access to treatment, making it easier for parents to get their child the critical care they need and deserve. I'm grateful for Senate President Spilka and all of my Senate colleagues for recognizing the importance of improving mental health care in our state and making it a priority this session.”
“This bill ensures that critical and timely health interventions are available to people experiencing trauma and mental illness—especially young people,” said Senator Julian Cyr (D-Truro), Chair of the Joint Committee on Mental Health, Substance Use, and Recovery. “When left untreated, trauma and mental illness can follow well into adulthood. Putting resources behind these interventions is a reaffirmation of the Senate’s commitment to transform access to mental health in the Commonwealth.”
The bill seeks to increase support for, and grow the pool of, foster parents in the Commonwealth through the establishment of a ‘Foster Parent Bill of Rights.’ Specifically, the bill includes several key rights important to foster families, including: access to training and resources; the right to appropriate communication between DCF, courts, and others involved with caring for the child; the right to be free from all forms of discrimination in carrying out their duties as foster parents; the ability to exercise rights without fear of repercussions; and establishing a reasonable and prudent parenting standard.
“This important bill will help the state do better business when it comes to serving one of the most at risk populations in our Commonwealth: children in DCF custody,” stated Senator Jo Comerford (D-Northampton). “My heartfelt thanks to Senators Sonia Chang-Diaz, Michael Rodrigues, and Senate President Karen Spilka for their dogged work on this legislation. I am delighted that the rights of foster parents will be enumerated, strengthening their role and responsibilities within this complex system.”
An Act relative to accountability for vulnerable children and families now moves to the House of Representatives for further action.
Senate Passes General Government, IT Bond Bill Conference Committee Report
The Massachusetts State Senate passed a General Government, IT Bond Bill Conference Committee Report today, which authorizes $1.8 billion in investments to modernize the Commonwealth’s general government infrastructure, improve cybersecurity capabilities, empower communities disproportionately impacted by the criminal justice system, support early education and care providers, and expand access to remote learning opportunities for vulnerable populations during the COVID-19 pandemic.
Senate-led priorities in the report include the following:
$65M in economic empowerment and justice reinvestment capital grants to support communities disproportionately impacted by the criminal justice system with access to economic and workforce development opportunities;
$50M to enhance and expand access to K through 12 remote learning technology for vulnerable populations during the COVID-19 pandemic;
$37M for a food security grant program to address infrastructure needs for farms, retailers, fisheries, food system food distribution channels to address growing food insecurity and food supply chain needs across the Commonwealth due to the COVID-19 pandemic;
$25M to assist licensed early education and care providers and after school programs with capital improvements to ensure safe reopening during the COVID-19 public health emergency;
$20M for a body camera grant program for police departments to ensure accountability in public safety;
$10M for a statewide criminal justice data system modernization to help better track racial and ethnic disparities across the judicial and public safety systems;
$5M for the creation of a common application option for Mass Health and Medicare Savings Program applicants to apply for SNAP at the same time, use the same core eligibility information and verifications;
$2.9M for public health data warehouse for the analysis of population health trends including health trends and health inequities related to the COVID-19 pandemic;
$2.5M for implementation of an automated electronic sealing process to seal certain criminal records.
The final bill now goes to the Governor for his signature.
