Legislative Updates

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. 

MSCO joined Massachusetts ACS CAN and other state organizations in letters of support, for the following federal bill, that were sent to all Massachusetts state congress members. H.R. 2407: the Nancy Gardner Sewell Medicare Multi-Cancer Early Detection Screening Coverage Act 

We requested that all members of the Massachusetts delegation support this most important bill. The early detection of cancer gives patients the greatest hope of beating the disease. This legislation recognizes the extraordinary unmet need in early detection of many different types of cancer, and will modernize Medicare, allowing the agency to determine coverage of multi-cancer early detection tests once FDA approved and when clinical benefit is shown, resulting in further reducing suffering and death from cancer for everyone.

The Massachusetts Society of Clinical Oncologists (MSCO) and the Association for Clinical Oncology (ASCO) are pleased to submit a letter of support of H. 982, a bill that would protect Massachusetts patients from non-medical switching of medications. MSCO and ASCO are encouraged by the steps that H. 982 takes toward improving continuity of care and preventing non-medical switching in Massachusetts. We urged the committee to vote for passage on this measure.

The Massachusetts Society of Clinical Oncologists (MSCO) and the Association for Clinical Oncology (ASCO) are pleased to support H. 953 / S. 609, companion bills which would take steps to protect patients with cancer in Massachusetts from copay accumulator programs. MSCO and ASCO are encouraged by the steps H. 953 / S. 609 take toward eliminating co-pay accumulator programs in Massachusetts, and we strongly urge the committee to pass the measure.

Testimony was submitted on behalf of the Massachusetts Society of Clinical Oncologists (MSCO). MSCO supports H.1074 and S.689, which would expand access to biomarker testing in the Commonwealth by requiring health insurers to cover such testing that meet nationally recognized criteria for such testing. MSCO believes that adequate insurance coverage for patients battling cancer, including needed biomarker testing, is needed to enable patients and their families to have access to the benefits of advanced cancer research and treatment.

In response to advocacy from the American Medical Association and organized medicine about the ongoing impacts of the COVID-19 public health emergency (PHE), the Centers for Medicare & Medicaid Services (CMS) will continueto allow physicians and group practices to apply for a MIPS Extreme and Uncontrollable Circumstances hardship exception to avoid up to a -9% MIPS penalty in 2025 based on 2023 performance. The exception will not be automatic, and interested physicians and groups must actively request reweighting of one or more MIPS performance categories due to the COVID-19 PHE. Requesting reweighting of all four MIPS performance categories will avoid a MIPS penalty in 2025. CMS expects to release the hardship exception application in spring 2023.

This is a big relief for physicians and their patients because CMS estimated in the final rule that up to one-third of MIPS eligible clinicians would have received a penalty due to the increasingly stringent requirements to participate in MIPS in 2023. It is also likely that small, rural, and practices serving underserved populations would have been disproportionately impacted by these penalties. We encourage you to spread the word to your members about this critical reprieve from up to a -9% penalty due to the COVID-19 PHE.

On April 5, 2023, the Centers for Medicare & Medicaid Services (CMS) released the 2024 Medicare Advantage and Part D Final Rule, which will revise regulations governing Medicare Advantage (MA), the Medicare Prescription Drug Benefit (Part D), Medicare cost plans, and Programs of All-Inclusive Care for the Elderly (PACE). The rule makes changes related to prior authorization, health equity, marketing and communications, and other areas on which Association for Clinical Oncology (ASCO) commented during the rulemaking process.