Legislative Updates

For the first time, April has officially been designated as National Cancer Prevention and Early Detection Month! We had over 80 organizations sign our letter of support of this effort. We are so grateful for each of you for your support! The Prevent Cancer Foundation is proud to have led this effort to spread the word that Early Detection = Better Outcomes. 

Below are a few resources related to this announcement. Please share with your networks far and wide! 

·        Official White House Announcement 

·        Prevent Cancer Foundation Press Release 

·        National Cancer Prevention and Early Detection Month website 

·        Partner Toolkit 

On March 7, the Massachusetts Joint Committee on Financial Services advanced bills that would ban copay accumulators and expand coverage for fertility preservation services for cancer patients. The Massachusetts Society of Clinical Oncology (MSCO) and the Association for Clinical Oncology (ASCO) sent joint letters of support ahead of hearings for both the copay accumulator and fertility preservation bills. Both bills were carried over from 2023 and have been referred to the Joint Committee on Health Care Financing. 

MOPSS Champions Vital Dental Bill H1094 for Cancer Survivors

Boston, MA – In a significant stride toward improving access to dental care for head and neck cancer survivors, Massachusetts Oncology Patients, Survivors, and Supporters (MOPSS) is thrilled to announce that House Bill 1094 (H1094) has been referred to the Joint Committee on Health Care Financing from the Joint Committee on Financial Services.

H1094, titled "An Act expanding coverage of dental procedures," aims to mandate insurers in Massachusetts to cover medically related dental treatment. The bill is a crucial step in addressing the unique challenges faced by head and neck cancer survivors, who often contend with oral health issues resulting from cancer treatments.

"We are excited about the progress of H1094 and grateful for the opportunity to present our case to the Joint Committee on Health Care Financing," said Thomas Healy, Founder of MOPSS. "This bill has the potential to make a profound impact on the lives of head and neck cancer survivors, ensuring they receive the necessary dental care to enhance their overall well-being."

The Joint Committee on Health Care Financing will play a pivotal role in reviewing and considering the merits of H1094. MOPSS looks forward to actively engaging with the committee and advocating for the bill's passage.

The bill, which has gained support from various quarters, addresses survivors' financial challenges due to the lack of insurance coverage for necessary dental procedures. MOPSS has been actively rallying for the inclusion of dental care, recognizing the interdependence of oral health and overall well-being, especially concerning medically related dental treatment.

MOPSS and all head and neck cancer survivors sincerely thank the Joint Committee on Financial Services for supporting House Bill 1094. In this pivotal moment, the collaboration between advocacy groups and legislative bodies represents a significant stride toward coverage for dental procedures, offering relief to survivors and enhancing their quality of life.

Read Bill & Letters Submitted>

Massachusetts Oncology Patients, Survivors, and Supporters (MOPSS)

House Bill 1094 (H1094) - An Act to expand dental care coverage

MOPSS (www.mopss.org)

Committee in Massachusetts advanced legislation this week that would ban copay accumulator programs in the state. The Association for Clinical Oncology (ASCO) submitted a joint letter of support ahead of these hearings with the Massachusetts Society of Clinical Oncology. The bill is now referred to the committee on Financial Services.

Last week, we saw the House Oversight Committee pass the House DRUG Bill (H.R. 6283). This bipartisan legislation would:

• Ban PBMs from charging fees based on a drug's list price, instead allowing PBMs to charge a flat fee for service; 
• Ban spread pricing, in which PBMs charge insurers more than they pay pharmacies; and
• Prohibit PBMs from steering patients to affiliated pharmacies.

Congressman Lynch also spoke on an amendment that would increase transparency and oversight of PBM practices. 

Continue this momentum and see meaningful PBM reform included in the March 8th CR package. Contact Senator Markey's and Representative Trahan's offices via email or social media to encourage their support for Senate Bill 1542 and H.R. 6283.

Bulletin 2024-03: https://www.mass.gov/doc/bulletin-2024-03-step-therapy-protocols-pursuant-to-chapter-254-of-the-acts-of-2022-chapter-254-issued-january-16-2024/download

Step therapy is defined as a “utilization management policy or program that establishes the specific sequence in which a prescription drug for a specified medical condition is covered by a carrier.”  This bulletin applies to fully insured Massachusetts licensed carriers that provide coverage for prescription drugs and outlines the process to request an exception to step therapy protocols. Exceptions may be requested when the drug required under the step therapy protocol is contraindicated, expected to be ineffective, has previously been tried and was ineffective and thus discontinued, or the patient is stable on a prescription drug prescribed by their provider and switching drugs will likely cause an adverse reaction. The exception request must be acted on not more than 3 business days following the receipt of all information or within 24 hours for urgent situations.  Carriers are expected to forward implementation plans to the DOI by February 15th.

Legislative activities on Beacon Hill are expected to move into high gear as we enter the final year of the 2023/2024 session. With formal sessions ending July 31, the window of opportunity to see passage of legislation now begins to narrow.

MSCO continues to push for action on our key legislative agenda:

• H.1074 & S.689, “An Act Relative to Cancer Patient Access to Biomarker Testing to Provide Appropriate Therapy” 

expands access to biomarker testing in the Commonwealth by requiring health insurers to cover such testing that meet nationally recognized criteria for such testing.

• H.1143 & S.1249 , “An Act to Improve the Health Insurance Prior Authorization Process”

· Prohibits insurers from retrospectively denying or revoking services when authorization already granted;

· Requires prior authorization approval to be valid for duration of treatment;

· Now, prior authorization determination within 2 business days. Bill would require determinations within 24 hrs. for urgent care;

· Insurers required to report prior authorization statistics to the state on services subject to prior authorization, % of approvals/denials, and % of approvals upon appeal. This will allow regulators and the public to understand the magnitude of the administrative burden of prior authorization on the delivery of health services.

• H. 953 & S. 609 “An Act Relative to Consumer Deductibles”

bans co-pay accumulator programs in Massachusetts.

• S.598 & H.1041, “An Act Relative to Preserving Fertility”

require insurance coverage of embryo, oocyte and sperm cryopreservation procedures for an insured patient who is at least age 18 and has been diagnosed with cancer but has not started cancer treatment.

• H.982 “An Act Relative to Non-medical Switching”

· would protect Massachusetts patients from non-medical switching of medications.

· prohibits health insurers from forcing a patient in the middle of the policy year to switch from a covered prescription drug to another medication as a result of an insurer’s decision to remove a covered prescription drug from its list of covered drugs or reclassify such drug to a more restrictive drug tier with a much higher co-pay

Report provided by Edward J. Brennan, Esq., MSCO Legislative Counsel

A paper in Cancer details three calls-to-action for the oncology research and care communities to expand access to clinical trials and improve inclusivity by enabling trial participation closer to patients’ homes. Authored by members of an American Society of Clinical Oncology task force, the paper illuminates tangible opportunities for change that would allow patients to receive trial-related testing and care near their homes, rather than having to travel to research institutions. Read More.

Sign Petition - Expand Access to Biomarker Testing in Massachusetts.

Biomarker testing helps connect patients with the right treatment at the right time. ACS CAN and partners, such as MSCO, are working together to make sure more Massachusetts residents can benefit from this important testing.

Policy action needed to ensure more Massachusetts residents benefit.

• Not all communities are benefiting from the latest advancements in biomarker testing and precision medicine.
• Communities that have been excluded, including communities of color, individuals with lower socioeconomic status, rural communities, and those receiving care in non-academic medical centers are less likely to receive biomarker testing.
• Improving coverage for and access to biomarker testing across insurance types is key to reducing health disparities.
• Without action to expand coverage and access to biomarker testing, advances in precision medicine could increase existing disparities in cancer outcomes by race, ethnicity, income, and geography.
• Insurance coverage for biomarker testing is failing to keep pace with innovations and advancements in treatment.

Have a cancer patient story? Share your story here.

Sign Our Petition - Expand Access to Biomarker Testing in Massachusetts.

The Senate Health, Education, Labor and Pensions (HELP) Committee recently held a markup and advanced four bills that regulate pharmacy benefit managers (PBMs) and increase patient access to necessary treatments. The Association for Clinical Oncology (ASCO) is advocating for PBM reform as we continue to hear from you and your colleagues about how challenging some PBMs are making it for patients to obtain access to their treatments and the additional administrative and financial burdens imposed on physicians. The Committee also considered many timely health care amendments, including language from the Safe Step Act (S. 652), to protect patients from harmful step therapy protocols. ASCO and other provider organizations and state societies, including MSCO, sent a letter to the Committee in advance of the mark up, urging the Committee to consider and advance the Safe Step Act. We were successful in our advocacy; the Safe Step Act language advanced out of Committee for the first time since its introduction.

Keep our advocacy going. Contact your lawmakers to urge them to cosponsor the Safe Step Act.