Bill > S827

This bill introduces comprehensive regulations for pharmacy benefits managers (PBMs) and healthcare organizations to ensure fair and transparent prescription medication pricing and access. The bill establishes detailed requirements for creating and managing maximum allowable cost (MAC) lists, which determine the reimbursement rates for drugs. Key provisions include mandating that drugs on MAC lists must be FDA-approved generics with multiple available sources, requiring PBMs to update these lists every three business days, and creating a clear appeals process for pharmacies that believe reimbursement rates are unfairly low. The legislation also requires PBMs to ensure reimbursement rates are at least equal to the pharmacy's acquisition cost and prohibits retroactive discounts. Additionally, the bill requires MassHealth Managed Care and Accountable Care Organizations to reimburse pharmacies at consistent rates and protects pharmacists' rights to disclose treatment alternatives and cost information to patients. The bill empowers the Insurance Commissioner to examine and audit PBM practices, with provisions to keep proprietary information confidential, ultimately aiming to increase transparency, fairness, and affordability in prescription medication access.

Business and Industry, Health and Social Services

https://malegislature.gov/Bills/194/S827