Legislative Updates

Dear All,

The House and Senate have come to agreement on two important health care bills: the Healthcare Market Review bill and the Pharmaceutical Access, Costs and Transparency bill. Both bills have been released as Conference Committee reports and will be passed by the legislature before the end of the year. Conference committee reports are unamendable, so no further changes can be made to the legislation. Both bills have been in the works for most of this session, but the House and Senate have been unable to come to a resolution on either bill since talks started in late July.

S.3012, An Act Relative to Pharmaceutical Access, Costs and Transparency

S.3012, the Drug Cost Bill, will ensure that patients will pay less for medication by limiting out-of-pocket costs for essential prescription drugs, promoting the affordability of health insurance premiums for consumers, and regulating pharmacy benefit managers.

H.5159, An Act Enhancing the Health Care Market Review Process.

H.5159, the Market Review Bill, is intended to address the ongoing fallout from the collapse of Steward Health Care and to prevent another such occurrence by increasing state oversight and regulation of private equity investors and management service organizations by the Health Policy Commission, the Center for Health Information and Analysis, the Attorney General, and the Division of Insurance. It also requires the licensure of Urgent Care Centers and of a new category called Office-Based Surgical Centers that perform ambulatory, surgical, or other invasive procedures requiring general anesthesia, moderate sedation, or deep sedation, excluding minor procedures and procedures requiring minimal sedation.

Noteworthy is that the final Market Review bill does not include the more onerous provisions in the Senate bill that would have prohibited certain contractual relationships with private equity investors and management service organizations and focuses more on reporting and transparency by hospitals and providers.

Dear MSCO member, I write with good news for oncologists and our patients!

“An Act Relative to Medically Necessary Breast Screenings and Exams for Equity and Early Detection” has been signed into law.  Chapter 231 of the Acts of 2025 will require health plans regulated by the Commonwealth to cover medically necessary screening and diagnostic breast imaging including diagnostic mammography, digital breast tomosynthesis (DBT), breast ultrasound, and magnetic resonance imaging (MRI), with no out-of-pocket costs. The law will also apply to patients insured by the Group Insurance Commission and MassHealth and will be effective for all contracts entered into, renewed or amended on or after January 1, 2026.  This legislation has been actively supported by MSCO since 2016. 

Oncologists see firsthand the heartbreaking financial decisions many of our patients face. We know early detection in diagnosing breast cancer can make an enormous difference. The passage of the Affordable Care Act ensures access to cancer screenings including mammograms without out-of-pocket costs. Unfortunately, individuals who require additional screening or diagnostic exams, or whose screening mammogram indicates a need for follow-up imaging tests, may face significant out-of-pocket costs, effectively becoming barriers that prevent patients from accessing lifesaving care.  By eliminating out of pocket costs for follow up breast imaging and exams, Chapter 231 will help increase access, save lives, and improve health outcomes.

Importantly, Chapter 231 will help reduce racial and ethnic disparities in breast cancer diagnosis and treatment. It is well known that minority women experience disparities at every level of care, including delays in diagnosis. This new law will ensure that all women can equitably access follow-up breast imaging and exams without concern for cost.

With the passage of Chapter 231, Massachusetts joins 23 states that have passed similar laws to fight breast cancer, including Maine, New Hampshire, Connecticut and Vermont.  Moreover, the Massachusetts Center for Health Information and Analysis (CHIA) determined that passage of this law will only result in an average annual increase to a member’s monthly health insurance premium of between $0.19 and $0.33 – a small price to pay to help us save lives.

MSCO was honored to be invited to Governor Maura Healey’s bill signing ceremony this week.  See photos below. 

On behalf of MSCO members across the Commonwealth, I wish to thank Governor Healey, the House and Senate leadership, and especially our legislative sponsors, including Sen. Michael Rush, Sen. Joan Lovely, Rep. James Murphy, and Rep. Ruth Balser, along with our organizational partners, the American Cancer Society, and Dana Farber Cancer Institute.

Lastly, thank you to all the MSCO members who supported our advocacy efforts with legislative meetings, public testimony, emails, letters and phone calls.  Your support for our patients and MSCO is much appreciated!

Sincerely,

Michael Constantine, MD

President

(Gov. Healy addressing audience)

(Gov. Maura Healy signing the bill)

(Signed Bill)

(Gov. Maura Healy & Dr. Eric Wong)

(Sen. Joan Lovely & Dr. Eric Wong)

(Sen. Bruce Tarr & Dr. Eric Wong)

STATE HOUSE, BOSTON, OCT. 28, 2024.....Legislation expanding access to more rigorous follow-up breast cancer screenings and exams, particularly for patients with abnormal results or dense breast tissue, cleared the Senate Monday after winning House approval in July.

The Senate-passed bill (H 4918) requires health insurers, including MassHealth, to cover diagnostic exams for breast cancer, digital breast tomosynthesis (DBT) screening, and "medically necessary and appropriate screening" with breast MRIs and ultrasounds.

Women are able to access preventive screening mammograms due to the Affordable Care Act. But lawmakers and cancer advocates say patients who need additional screenings and exams may be forced to forego doctors' orders due to steep out-of-pocket costs, which could tally hundreds or thousands of dollars.

Sen. Joan Lovely, who said she has dense breast tissue and needs 3D mammography in order for radiologists to properly screen her, said the bill will save lives by catching breast cancer early.

"This bill prohibits any increase in patient cost-sharing, as in deductibles and copayments for these diagnostic exams, and does not require pre-authorization," Lovely said prior to the Senate vote. "So really, this does really open up this latest technology to everyone who might need a 3D mammography, which is really state of the art."

The House passed its version of the bill in late July. The bills are largely similar, though the House version would take effect on Jan. 1. 2025, compared to the Senate implementation date of Jan. 1, 2026.

The bill is endorsed by the Dana-Farber Cancer Institute, Susan G. Komen breast cancer organization, the Massachusetts Radiological Society and the American Cancer Society, Lovely said.

The society describes DBT as "modern mammography" that "acquires volumetric imaging of the breast" and "provides a clearer and more accurate view compared to traditional mammography." DBT offers clearer and more accurate images for women with dense breast tissue, provides earlier detection of small breast cancers, and results in fewer unnecessary biopsies and tests, according to MRS.

Sen. Mike Rush said one in 10 women require follow-up screenings after initial mammograms. Rush said many patients cannot afford those out-of-pocket costs, as he invoked a $1,000 price tag, based on a Susan G. Komen study.

"These costs create huge health disparities across income and racial lines," Rush said. "Women with lower incomes or whose work insurance may provide less comprehensive coverage, which is disproportionately true of women of color, may delay or never pursue a follow-up. We know how important it is to identify and begin treatment quickly when fighting cancer, and any failure or delay in catching these signs can be fatal. No woman should have to die because they had to choose between paying to keep a roof over their head or food in their children's mouth, and their medically necessary cancer screenings."

More than 4,000 women in Massachusetts have died from breast cancer since 2016, Rush said. He called the bill "morally necessary and fiscally responsible," pointing to a study from the Center for Health Information and Analysis that found the insurance change could raise monthly premiums by 19 to 33 cents for members.

Sen. Walter Timilty said the expanded insurance coverage would enable Massachusetts to better care for vulnerable residents, and he also touted the life-saving reach of the bill.

"It is how we are judged: How do we treat those in our society who are ill, who are suffering, and do not have the means to provide for their own medical care?" said Timilty.

Senators on Monday also passed legislation (S 2970) requiring health insurance coverage of different types of therapy, including applied behavioral analysis (ABA) therapy, for individuals with Down syndrome. The House has not taken up the bill yet.

Sen. Julian Cyr said ABA therapy allows children with intellectual disabilities and learning differences to develop skills such as speaking, playing, making friends, feeding, dressing and going to the bathroom, as well as manage challenging or unsafe behaviors like self-injury. For now, he said access to the therapy is limited to children whose parents are able to navigate the complex health insurance system or afford to pay out of pocket.

"The average course of treatment for ABA services includes between 10 and 20 hours per week, for a total across about 12 months, which would, at roughly $120 an hour, result in quite a hefty price tag for families who are paying privately," Cyr said. He added the bill would promote "equitable access of this transformative therapy."

In a recent letter to The Boston Globe, Dr. Eric Wong, former president of the Massachusetts Society of Clinical Oncologists (MSCO), along with several of his esteemed colleagues, responded to the op-ed “A bold blueprint to combat cancer,” which highlighted the ambitious plans for the new Mass General Brigham (MGB) Cancer Center. While the proposal outlines a hopeful vision for the future of cancer care, Dr. Wong pointed out that the reality for many patients and providers is far more complex.

Read more the full letter "For many, cancer care blueprint is still very much in draft phase" to the editor here.

Joining with the Association for Clinical Oncology (ASCO) and 45 other state societies, MSCO signed onto a Congressional letter urging lawmakers to protect our nation's cancer patients by taking steps to mitigate cancer drug shortages.

As you know, ASCO has been advocating for Congress to take action, urging House and Senate leadership to enact the following recommendations:

• Address economic factors that drive generic manufacturers out of the market and consider stabilizing the market with long-term contracts and guaranteed prices.

• Reward reliable U.S. manufacturing of critical and supportive medications through price stabilization and investment in continuous manufacturing or other advanced manufacturing.

• Recognize potential shortages earlier by increasing the FDA’s visibility into the supply chain so the agency can predict and respond to potential shortages earlier.

• Relay information about potential shortages to health systems and providers to help them prepare for and mitigate possible supply challenges.

The Association for Clinical Oncology (ASCO) and many State Societies including MSCO signed onto the Congressional letter in support of the recently reintroduced Improving Seniors' Timely Access to Care Act (H.R. 8702/S. 4532). Please find the official letter that was sent to Congress.

As Congress returns from the August recess, ASCO continues to advocate for Congress to pass the Improving Seniors' Timely Access to Care Act, (H.R. 8702/S. 4532), and you can help in these efforts. Please take a moment to visit the Act Network and provide your support for passage of prior authorization reform. 

The House and Senate were unable to reach agreement on significant policy issues like health care reform prior to the close of the formal legislative session on August 1. While the conclusion of the formal session usually means the end of major policy initiatives for the session, there is talk on Beacon Hill that the legislature will try to resolve their differences and pass important initiatives during the informal sessions which runs until the end of the year. Passage of bills during an informal session can be difficult because it requires unanimous consent. There is also talk of returning for a Special Session to take up an economic development bond bill which requires a roll call vote.

With that in mind, I want to highlight some important health care issues MSCO has monitored during the session which are still pending and, if some compromise can be reached, passage in an informal session is possible. 

Read full report>

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

On July 24, the Massachusetts House unanimously advanced a health care package that includes a provision banning copay accumulators in the state. Since the House amended the bill, which previously passed the Senate in November, a conference committee has been established to resolve the differences between the two versions. The Association for Clinical Oncology and the Massachusetts Society of Clinical Oncology joined a coalition letter urging members of the conference committee and House and Senate leadership to retain the copay accumulator language in the final version.

The Legislature today passed the FY25 State Budget. Included in the budget is the Fertility Preservation language that was originally the free standing bill, S.598, which MSCO has strongly supported. Both the House and Senate in their separate budget bills had included the language. Now the language is before the governor for her approval, which is expected.

A copy of the language is attached here. This language covers commercial insurers. Similar language is in the bill covering all other state regulated health insurance such as BCBS, HMOs, etc. 

Today, we join forces with other organizations in urging Massachusetts legislators to reform Pharmacy Benefit Managers (PBMs). PBMs often keep rebates intended for patients and favor more expensive drugs, driving up costs. With PBMs controlling nearly 80% of the market, it’s crucial to address their practices that often increase patient costs and limit access to essential medications. Our aim is to promote transparency, support community pharmacies, and prioritize patient care. 

Read the full letter and join us in advocating for meaningful change.