New regulations issued by the Massachusetts Division of Insurance prohibit the use of prior authorization requirements for a wide range of healthcare services. The rules, which took effect on June 5, 2026, affect fully insured health insurance issued in the Commonwealth, and can be downloaded from the Division’s website. Services that no longer may be subject to prior authorization include emergency and urgent care, primary care, preventive services, radiology imaging after a cancer diagnosis, maternity care, outpatient substance use disorder treatment, physical and occupational therapy, and medications for serious mental illness and certain chronic conditions.
The rules also require insurers to respond to urgent health-sensitive prior authorization requests within 24 hours. Patients with chronic conditions, including cancer, who receive authorization for treatment must have their approvals honored for the duration of their treatment as long as they remain stable. Further, if a patient switches insurance coverage mid-treatment, the new carrier must honor existing authorizations for at least 90 days. Insurers will also be required to publicly post prior authorization requirements and notify providers in advance before making changes to their policies.
The Division of Insurance also issued new guidance requiring health insurers offering small group coverage in Massachusetts (up to 100 employees) to limit participant out-of-pocket cost-sharing increases to 3.6 percent for 2027. The guidance can be downloaded from the Division’s website. This action is the result of legislation signed by Governor Healey in 2025 that increased the Insurance Commissioner’s ability to regulate consumer cost-sharing.
All employers offering fully insured health insurance coverage in Massachusetts and their plan participants will see the impact of the changes to prior authorization requirements over the next few months. Small employers offering fully insured group health plans will notice the results of the new cost-sharing limitations in 2027 plan designs.