Bill > H4493

This bill aims to regulate pharmacy benefit managers (PBMs) and ensure fair access to prescription medications through several key provisions. The legislation defines terms like "brand name drug" and "generic drug" and establishes rules for pharmacy contracts and reimbursement. PBMs must now pay pharmacies an ingredient cost and dispensing fee at least equal to the Massachusetts Medicaid Program rates, and cannot use retroactive discounts or engage in "pharmacy steering" (directing prescriptions to pharmacies they own). The bill requires PBMs to allow any licensed Massachusetts pharmacy to provide medications, including specialty medications, under the same service requirements. It also creates a detailed process for pharmacies to appeal maximum allowable cost (MAC) lists, mandating that PBMs update these lists every three business days and provide transparent information about drug pricing. Additionally, the bill prohibits PBMs from charging community pharmacies for credentialing, limits their ability to recoup payments during audits, and requires them to report denied pharmacy appeals annually to the Insurance Commissioner. The legislation aims to protect community pharmacies, ensure fair compensation, and increase transparency in prescription drug pricing and distribution.

Health and Social Services

Joint Committee on Financial Services (Joint)

https://malegislature.gov/Bills/194/H4493