Gov. Maura Healey announced a health insurance reform Wednesday aimed at cutting patients’ wait time for treatment.
Under new state regulations, doctors will no longer need to seek pre-approval from a patient’s health insurer before providing care in “a whole bunch of situations,” Healey said.
“We’re cutting the red tape that stands between you and health care,” she said. “From now on, a wide range of medical drugs, services, and equipment will no longer need any prior authorization at all.”
The change will apply to services including primary care, chronic disease management, reproductive and maternity care, physical therapy and substance use treatment, Healey said.
For example, she said a patient with diabetes will no longer need an insurer’s prior authorization for insulin, pumps or other devices and drugs they may need.
“You won’t need it for the first time or for subsequent appointments,” Healey said. “You won’t need it for any adjustments or upgrades that you get. And you won’t need it if you change jobs either.”
All health insurers that do business in Massachusetts will be subject to the new regulations, state insurance commissioner Michael Caljouw said. Healey plans to file the regulations this week, and there will be a public comment period before they take effect.
Foreshadowing the possibility of further reform proposals in the future, Healey on Wednesday also launched a new working group focused on health care affordability. She said she wants the members to put forward ideas by June.
“I’m setting up this working group because I want action, OK?” Healey said. “I don’t want a protracted process where we study an issue for months or years at a time and come out with some blue-ribbon report.”
Despite state efforts to monitor and contain costs, climbing health care expenses continue to squeeze household and employer budgets.
The state’s Center for Health Information and Analysis found that in 2025, more than a quarter of Massachusetts residents said they or a family member went without needed health care because of cost. According to another state agency, the Health Policy Commission, Massachusetts now has the highest family health insurance premiums in the country.
“There are far too many families making decisions about health care based on whether or not they’ll be able to pay for their groceries, pay for their rent, or heat their homes,” said Dr. Kiame Mahaniah, Healey’s health and human services chief, “Our health care system has reached a breaking point where costs are fast outpacing our ability to pay for care.”
Lisa Murray, the Massachusetts president at Citizens Bank, and Kate Walsh, a former state health secretary, will lead the new affordability panel. Other members include state lawmakers, business leaders and health care industry representatives.
Mahaniah said the group will explore ways to make the system more efficient, innovative ways to pay for services and how to use technology to improve patient care.
