Evidence status: CURRENT INSURANCE ACCESS REFORM, EFFECTIVE JULY 1, 2025 FOR COVERED CONTRACTS. Massachusetts expanded state insurance requirements for pain-management services through Chapter 285 of the Acts of 2024.

Broad pain-management access plans

For covered insured health plans entered into, renewed, or amended on or after July 1, 2025, carriers must develop plans providing adequate coverage and access to a broad spectrum of pain-management services, including non-medication, nonsurgical modalities and non-opioid medications that serve as alternatives to opioid prescribing.

No prior authorization for certain non-medication services

Covered plans may not require prior authorization for covered non-medication, nonsurgical pain-management modalities identified in the carrier’s plan, including restorative therapies, behavioral-health approaches, acupuncture, chiropractic treatment, massage, and movement therapies.

Utilization controls for non-opioid drugs

State law also limits carriers from imposing utilization controls on clinically appropriate non-opioid pain medications that are more restrictive than the least restrictive controls applied to clinically appropriate opioid drugs.

Carrier review

The Division of Insurance considers whether carrier policies create unduly preferential coverage for opioid prescribing over other pain-management modalities.

Coverage boundary

State-mandated insurance benefits do not necessarily reach self-funded employer plans governed by federal law. The Division of Insurance notes that many large-employer self-funded plans are exempt from these Massachusetts mandated-benefit requirements.

Relationship to Contract for Care

The 2025 coverage reforms expand access to alternatives and address insurance barriers. They do not repeal the written treatment-agreement mandate in M.G.L. c.94C §18A.

Sources

Reviewed: October 4, 2026.