MA| The Massachusetts Division of Insurance Bulletin 2025-03 provides updated guidance to commercial health insurers and HMOs regarding mandatory coverage for vaccines in Massachusetts-issued insured health plans, in line with Department of Public Health (DPH) recommendations. Carriers must clearly explain vaccine benefits in member materials and are required to cover recommended vaccines—including administration costs—without cost-sharing, utilization management, or unnecessary barriers for eligible members. Carriers may structure access through formularies or provider networks, but coverage must include all DPH-recommended vaccines, and they are urged to encourage similar standards for employer-sponsored non-insured plans.
Key Points
- Vaccine coverage must be provided without cost-sharing or utilization management, and member materials must clearly explain benefits.
- Carriers may use drug formularies or closed networks but must ensure access to all DPH-recommended vaccines through at least one formulary product or network provider.
- Carriers acting as plan administrators should urge employer-sponsored plans to follow these coverage guidelines and make sponsors aware of DPH recommendations