The proposed bill seeks to regulate non-medical switching practices by health carriers concerning prescription drug coverage. It introduces a new section to Chapter 175 of the General Laws, defining terms such as "nonmedical switching," "coverage exemption," and "covered person." The bill prohibits health carriers from limiting or excluding coverage for a prescription drug if the covered person is medically stable on that drug, provided it was previously approved and prescribed within the last six months. It also mandates that coverage for such drugs continues throughout the covered person's eligibility under the health benefit plan, including during open enrollment periods. Additionally, the bill outlines specific prohibited actions, such as increasing cost-sharing or moving a drug to a more restrictive formulary tier, unless certain safety conditions are met.

Furthermore, the bill establishes a clear process for requesting coverage exemption determinations, requiring health carriers to respond within specified timeframes. If a request is denied, the covered person has the right to appeal, and the health carrier must provide reasons for the denial and information on how to appeal. The bill clarifies that it does not prevent healthcare professionals from prescribing necessary medications or health carriers from making formulary changes under certain conditions. The provisions of this bill will apply to health benefit plans delivered or renewed in the state on or after January 1, 2026.