Bill > S715

This bill aims to ensure access to prescription medications by providing several key provisions: 1. It establishes requirements for pharmacy benefit managers (PBMs) and covered entities when using "maximum allowable cost lists," which set the maximum amount they will reimburse pharmacies for drugs and medical products. This includes requiring the drugs to be listed in the FDA's Orange Book, having at least two therapeutically equivalent generic options, and removing drugs that no longer meet these requirements within 3 business days. 2. It requires PBMs and covered entities to provide pharmacies with the sources used to determine maximum allowable costs, the specific costs for individual drugs, and the full maximum allowable cost lists upon request. It also mandates that the maximum allowable cost be equal to or greater than the pharmacy's acquisition cost. 3. It creates a process for pharmacies to contest the maximum allowable cost for a drug or product, with timelines for the PBM or covered entity to respond and make any necessary adjustments. 4. It prohibits PBMs from applying retroactive discounts and requires them to include the full payment for covered medications in their explanation of benefits. 5. For MassHealth Managed Care Organizations and Accountable Care Organizations, it requires them to reimburse pharmacies at the same rate as described in the MassHealth Pharmacy Provider Manual. Overall, the bill aims to increase transparency, fairness, and access to prescription medications for both pharmacies and patients.

Business and Industry, Health and Social Services

https://malegislature.gov/Bills/193/S715