Bill > H1324

This bill establishes comprehensive regulations for Pharmacy Benefit Managers (PBMs) in Massachusetts, aiming to increase transparency and fairness in prescription drug pricing. The legislation requires PBMs to obtain a license from the insurance commissioner, who can investigate and penalize non-compliant organizations. Key provisions include mandating that PBMs disclose pricing information to covered entities, update maximum allowable cost (MAC) pricing at least every 7 days, and ensure drugs on MAC lists are FDA-rated as therapeutically equivalent and widely available. The bill establishes a detailed appeals process for pharmacies to challenge reimbursement amounts, requiring PBMs to respond within 10 business days and provide specific reasons for any denials. PBMs are prohibited from requiring additional accreditation beyond state pharmacy board standards and must maintain a dedicated contact point for pricing and appeal inquiries. Additionally, the legislation allows pharmacies to decline services if reimbursement is less than their cost of providing those services. These regulations aim to create more accountability in the prescription drug supply chain and protect pharmacies and consumers from potentially unfair pricing practices.

Business and Industry, Health and Social Services

https://malegislature.gov/Bills/194/H1324