Bill > H1364

This bill introduces two key provisions aimed at improving healthcare access and affordability. First, it mandates that health insurance carriers and pharmacy benefit managers (PBMs) pass at least 80% of estimated pharmaceutical rebates to insured patients by reducing their out-of-pocket costs at the point of sale. The bill defines complex terms like "estimated rebate" and "price protection rebate" and requires carriers to file annual reports demonstrating compliance, with potential fines up to $5,000 per day for non-compliance. Importantly, the bill also protects the confidentiality of rebate-related information, treating it as a trade secret. Second, the bill requires the Health Policy Commission and the Secretary of Health and Human Services to conduct a comprehensive analysis of cell and gene therapy access in Massachusetts, focusing on potential barriers for MassHealth (the state's Medicaid program) beneficiaries and vulnerable populations. This analysis, to be completed by July 30, 2028, will project the number of upcoming cell and gene therapy treatments, assess current reimbursement frameworks, identify potential access barriers, and propose policy solutions to ensure equitable access to these advanced medical treatments. The bill reflects a proactive approach to addressing healthcare affordability and access to cutting-edge medical technologies.

Budget and Finance, Business and Industry, Health and Social Services

https://malegislature.gov/Bills/194/H1364