Massachusetts Governor Maura Healey has announced measures to reform the state’s health care system with the goal of improving accessibility and affordability. The administration is implementing regulatory changes to streamline prior authorization requirements for certain health care services and medications. Details of the plan were provided in a statement released today.
Governor Healey’s administration has introduced reforms aimed at improving access to health care. A Health Care Affordability Working Group has been established to support efforts to reduce costs across the state’s health care system. The updated regulations from the Division of Insurance (DOI) seek to remove prior authorization requirements for various services, including emergency care, primary care, chronic care, and certain prescription medications.
The changes affect patients by removing prior authorization requirements for diabetes services, devices, and medications, maintaining authorization for rheumatoid arthritis treatments when patients change insurance providers, and requiring a 24-hour response for urgent authorization requests. These updates aim to streamline administrative processes for both health care providers and patients.
According to an official announcement, these reforms are of "moment of urgency," an ambitious stride against the status quo that has often placed insurmountable barriers between individuals and their essential health care needs. Economic Development Secretary Eric Paley concurred, emphasizing the importance of an "affordable, efficient, and reliable health care system" for a competitive economy. The health care industry spent an alarming $1.3 billion on administrative costs related to prior authorizations in 2023, with documentation indicating a 30 percent year-on-year increase fueled by the growing volume of prior authorization requests.
Senate President Karen E. Spilka and Commissioner of Insurance Michael Caljouw noted the complexity of prior authorization requirements and the challenges they pose for patients and providers. The newly formed Health Care Affordability Working Group, co-chaired by former Health and Human Services Secretary Kate Walsh and Citizens Massachusetts President Lisa Murray, will examine factors contributing to high health care costs and develop recommendations to reduce expenses while maintaining access and quality of care.
The press release highlighted Massachusetts’ ongoing efforts to advance health care reforms. The Health Care Affordability Working Group, which includes representatives from government, industry, labor, and academia, will contribute to developing strategies for a more affordable and sustainable health care system. The group is expected to play a key role in guiding long-term improvements in health care costs and service delivery across the state.
