MA S693

Prohibits health carriers from limiting or excluding coverage of prescription drugs for patients who are medically stable on their current medication, as determined by their prescribing health care professional, if the drug was previously approved and prescribed within the past six months

Bans mid-year formulary changes that reduce maximum coverage, increase cost sharing, move drugs to more restrictive tiers, or remove drugs from formularies (unless FDA has raised safety concerns or the manufacturer has discontinued the drug)

Requires health carriers to respond to coverage exemption requests within 72 hours (24 hours for urgent cases), with automatic approval if no response is received within the deadline

Establishes an appeals process for denied coverage exemptions, with decisions required within 72 hours (24 hours for urgent cases), and allows external review under Chapter 514J if denials are upheld

Applies to health benefit plans delivered, issued, continued, or renewed in Massachusetts on or after January 1, 2026, and amends Chapters 175, 176A, 176B, and 176G of the General Laws