An Act to ensure access to prescription medications

This bill (SD 85) establishes rules for pharmacy benefits managers and covered entities regarding reimbursement rates for prescription drugs. It requires that drugs placed on "maximum allowable cost lists" (reimbursement limits) must meet specific FDA rating criteria and have therapeutically equivalent alternatives available. Pharmacies must receive transparent cost information, and reimbursement rates must cover actual pharmacy acquisition costs (using National Average Drug Acquisition Cost as a benchmark). The bill also creates a 7-business-day appeals process for pharmacies to challenge rates, with retroactive payment adjustments if appeals are approved, and prohibits retroactive discounts on claims. These requirements apply to all pharmacy benefits managers and covered entities operating in Massachusetts.