Bill > H1330

This bill introduces new regulations for pharmacy benefit managers (PBMs) in Massachusetts, focusing on ensuring fair reimbursement practices for pharmacies. The legislation defines key terms like "maximum allowable cost list" (a list used by PBMs to set reimbursement rates) and establishes requirements for how these lists are created and maintained. PBMs must now ensure drugs on their lists are therapeutically equivalent, available from wholesalers, and not obsolete. The bill mandates that PBMs provide transparent access to their cost lists, update them within 7 days of significant price changes, and create an administrative appeal process for pharmacies to challenge reimbursement rates. Importantly, PBMs cannot reimburse independent pharmacies at rates lower than their own affiliated pharmacies for the same services. Pharmacies can decline to provide services if the reimbursement would be less than their acquisition cost. The bill also applies to PBMs working with MassHealth and the group insurance commission, and violations are considered deceptive trade practices. The overall goal is to protect pharmacies from potentially unfair pricing practices and ensure they can sustainably provide pharmaceutical services.

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https://malegislature.gov/Bills/194/H1330