Bill > H1157

This bill aims to regulate pharmacy benefit managers (PBMs) and ensure fair practices in prescription drug services. The legislation defines key terms like "brand name drug" and "generic drug" and establishes rules for pharmacy contracts and reimbursement. It requires PBMs to pay pharmacies an ingredient cost and dispensing fee comparable to the state Medicaid program, prohibits retroactive discounts, and mandates that payment to non-affiliated pharmacies must be equal to or greater than payments to PBM-owned pharmacies. The bill prevents "pharmacy steering" (directing prescriptions to PBM-owned pharmacies) and requires PBMs to allow any licensed Massachusetts pharmacy to provide medications, including specialty medications. Additionally, the bill creates a detailed process for pharmacies to appeal maximum allowable cost (MAC) lists, mandates frequent updates to these lists, and requires transparency in drug pricing. The legislation also limits PBM audit practices, prohibits charging pharmacies for credentialing, and gives the Insurance Commissioner authority to enforce these regulations and conduct audits. The overall goal is to protect community pharmacies, ensure fair compensation, and increase transparency in prescription drug services.

Business and Industry

https://malegislature.gov/Bills/194/H1157