Massachusetts Bill with Key Pain Provisions Passed in December, 2024
Cindy Steinberg, Policy Chair, Massachusetts Pain Initiative
The bill, now law, is a large SUD bill entitled An Act relative to treatments and coverage for substance use disorder and recovery coach licensure that we were successful in inserting several key pain provisions in. The bill number is H.5143 and it was signed by the Governor on December 23rd.
It builds on work we did on a prior law called the CARE Act signed in 2018. That law required private payers and the state employee group insurance plans to cover a broad spectrum of pain management services.
The regulations written pursuant to that law required payers to submit their pain management plans to the DOI in order to be accredited each year and required coverage of 2 non-opioid pain medications and 3 non-pharmacological treatments. Payers could choose these medications and non-pharma treatments.
This new law goes further:
- making certain non-medication treatments such as acupuncture, physical therapy, chiropractic, massage and movement therapies currently being offered by insurers to comply with the Division of Insurance Guidance pursuant to the CARE Act available to patients with no prior authorization requirements.
- requires insurers to annually distribute educational materials to members and providers about their pain management plans
- requires practitioners to complete training on the full range of evidenced-based pain management treatments specified in the Pain Management Best Practices Task Force Report issued by the U.S. Department of Health and Human Services,
- Requires pharmacists to distribute educational materials for patients on the non-opioid pain management treatments specified in the HHS Pain Managment Best Practices Task Force Report. The materials will be created by the DPH.
- Ensures there is parity for non-opioid medications – meaning there are no utilization controls like prior authorization or step therapy on non-opioid medications that are more restrictive than those on opioids.