Bill > H4346

This bill aims to regulate pharmacy benefits managers (PBMs) and ensure fair prescription medication access by establishing several key provisions. The bill defines "maximum allowable cost list" as a pricing mechanism used by PBMs for reimbursing pharmacies and mandates that drugs on such lists must meet specific criteria, including being FDA-approved and having multiple equivalent generic alternatives. PBMs must update these cost lists every three business days, make them transparently available to pharmacies, and ensure reimbursement rates are at least equal to pharmacies' acquisition costs. The bill creates a formal appeals process for pharmacies to contest drug pricing, requiring PBMs to respond to appeals within seven business days and retroactively adjust costs if an appeal is determined valid. Additionally, the bill prohibits retroactive discounts and requires PBMs to include medication payment details in their explanation of benefits. For MassHealth programs, the bill mandates that Managed Care and Accountable Care Organizations reimburse pharmacies at rates specified in the MassHealth Pharmacy Provider Manual. The legislation also protects pharmacists' rights to disclose treatment information and alternative drug options to patients, preventing PBMs from penalizing pharmacies for providing such transparent pricing and clinical guidance.

Health and Social Services

Joint Committee on Financial Services (Joint)

https://malegislature.gov/Bills/194/H4346