An Act to ensure access to prescription medications

H 4346 requires pharmacy benefits managers (PBMs) and insurers to follow specific rules for setting maximum allowable costs (MACs) for prescription drugs. Drugs must have available therapeutic equivalents to be listed on MACs, and PBMs must remove them if they no longer meet criteria within 3 business days. The bill mandates transparency by requiring PBMs to share MAC sources, costs, and lists with pharmacies, and creates an appeal process for pharmacies to challenge low MACs, with retroactive payment adjustments if appeals succeed. It also prohibits retroactive discounts and requires MassHealth to reimburse pharmacies at the rate specified in the state’s pharmacy provider manual.