Bill > S831

This bill aims to regulate pharmacy benefit managers (PBMs) and ensure fair access to prescription medications through several key provisions. The legislation defines terms like "brand name drug" and "generic drug" and establishes rules for pharmacy contracts, reimbursement, and audits. Specifically, PBMs must pay pharmacies an ingredient cost equal to or greater than the Massachusetts Medicaid Program's rate, provide a dispensing fee no less than the Medicaid rate, and prohibit retroactive discounts. The bill mandates that PBMs allow any licensed Massachusetts pharmacy to provide medications, including specialty medications, and prevents pharmacy steering (directing prescriptions to pharmacies in which the PBM has an ownership interest). It also creates a detailed appeals process for pharmacies to contest drug cost lists, requires PBMs to update maximum allowable cost lists every three business days, and limits audit recoupments to cases of significant errors. Additionally, the bill prohibits PBMs from charging community pharmacies for credentialing and requires annual reporting of denied pharmacy appeals to the Insurance Commissioner, who is tasked with enforcing these regulations and maintaining the confidentiality of examined records.

Business and Industry, Health and Social Services

https://malegislature.gov/Bills/194/S831