Updates
Amended by St. 2024, c. 285, § 1, applicable to all contracts entered into, renewed or amended on or after July 1, 2025.
Section 17Q (effective until July 1, 2025)
(a)
The commission shall develop a plan to provide active or retired employees adequate coverage and access to a broad spectrum of pain management services, including, but not limited to, those that serve as alternatives to opioid prescribing, in accordance with guidelines developed by the division of insurance.
(b)
The plan shall be subject to review by the division of insurance. In its review, the division shall consider the adequacy of access to a broad spectrum of pain management services and any carrier policies that may create unduly preferential coverage to prescribing opioids without other pain management modalities.
(c)
The commission shall distribute educational materials to providers within their networks about the pain management access plan and make information about its plan publicly available on its website.
Section 17Q (effective July 1, 2025; see note)
[Amended by St. 2024, c. 285, § 1, applicable to all contracts entered into, renewed or amended on or after July 1, 2025.]
(a)
The commission shall develop a plan to provide active or retired employees insured under the group insurance commission adequate coverage and access to a broad spectrum of pain management services, including, but not limited to, non-medication, nonsurgical treatment modalities and non-opioid medication treatment options that serve as alternatives to opioid prescribing, in accordance with guidelines developed by the division of insurance.
(b)
No such coverage offered by the commission shall, relative to pain management services identified by the commission pursuant to subsection (a), require a member to obtain prior authorization for non-medication, nonsurgical treatment modalities that include restorative therapies, behavioral health approaches or integrative health therapies, including acupuncture, chiropractic treatments, massage and movement therapies.
(c)
(1)
The plan developed pursuant to subsection (a) shall be subject to review by the division of insurance. In its review, the division shall consider the adequacy of access to a broad spectrum of pain management services and any policies that may create unduly preferential coverage to prescribing opioids without other pain management modalities.
(2)
No coverage offered by the commission to an active or retired employee of the commonwealth insured under the group insurance commission shall establish utilization controls, including prior authorization or step therapy requirements, for clinically appropriate non-opioid drugs approved by the United States Food and Drug Administration for the treatment or management of pain that are more restrictive or extensive than the least restrictive or extensive utilization controls applicable to any clinically appropriate opioid drug.
(d)
The commission shall annually distribute educational materials to providers within their network and to members about the pain management access plan developed pursuant to subsection (a) and shall make information about the plan publicly available on its website.
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| Last updated: | December 23, 2024 |
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