Bill > H4488

This bill introduces new regulations for pharmacy benefit managers (PBMs) in Massachusetts, focusing on how they reimburse pharmacies for prescription drugs. The legislation defines key terms like "maximum allowable cost list" (a list of drugs used to set reimbursement rates) and establishes several important requirements for PBMs. Specifically, before adding a drug to their maximum allowable cost list, PBMs must ensure the drug is therapeutically equivalent, available from wholesalers, and not obsolete. PBMs must provide pharmacies with access to their cost lists, update them within 7 days of significant price changes, and create an administrative appeal process that allows pharmacies to challenge reimbursement rates. The bill also prohibits PBMs from reimbursing independent pharmacies at rates lower than what they pay their own affiliated pharmacies for the same services. Pharmacies are given the right to decline providing services if the reimbursement would be less than their acquisition cost for a drug. The legislation applies to PBMs working with MassHealth and the group insurance commission, and violations will be considered unfair trade practices. The overall goal is to create more transparency and fairness in drug pricing and reimbursement for pharmacies in Massachusetts.

Health and Social Services

Joint Committee on Financial Services (Joint)

https://malegislature.gov/Bills/194/H4488