This bill expands eligibility for paid caregiving under MassHealth's home and community-based services program. It directly affects legally liable family members (including parents, guardians, adult children, and others with legal responsibility) who currently may be excluded from being paid caregivers. The key provision amends the law to explicitly include these individuals within the definition of "family member" for payment purposes, removing barriers imposed by existing statutes. MassHealth must then file a required state plan amendment or waiver to implement this change. The policy change modifies program eligibility rules without altering funding or creating new services.
This bill (HD 2860) extends prior authorization periods for community-based long-term care services to up to five years for MassHealth members with chronic conditions. It directly affects MassHealth members with persistent health conditions (including intellectual/developmental disabilities) requiring services like Adult Day Health, Home Health Aide, or Adult Foster Care. The key provision replaces shorter, recurring authorizations with multi-year approvals, while allowing modifications if a member's condition changes. This reduces administrative burdens for members and providers, ensuring uninterrupted access to necessary care under defined service plans.
This bill allows court-appointed guardians to be paid directly for arranging medical care for incapacitated people (those unable to make their own health decisions). It creates specific rules for guardians to qualify as "providers," requiring proof of court appointment, a sworn statement of service dates, and confirmation they are not immediate family members (spouse, parent, child, or sibling). Guardians must submit claims with court documents, and payments cannot duplicate existing insurance coverage. The law also sets new payment rates for guardians based on regional costs, inflation, and geographic wage differences.
This bill requires pharmacy benefit managers (PBMs) in Massachusetts to set and update drug reimbursement rates based on transparent, standardized criteria. It mandates that PBMs provide pharmacies with timely access to their "maximum allowable cost" lists, allow pharmacies to challenge rates below their actual drug purchase costs, and offer a 7-day appeal process for disputes. Pharmacies can refuse to dispense drugs if reimbursement would be lower than their acquisition cost, and PBMs must reimburse pharmacies at least as much as they pay their own affiliated pharmacies. The law applies to all PBMs serving MassHealth and similar programs, with violations treated as unfair trade practices.
This bill prohibits discrimination against entities participating in the federal 340B drug discount program. It requires insurers and drug distributors to pay 340B-covered entities (like community health centers and safety-net hospitals) and their contract pharmacies the same rate as non-340B providers for covered drugs, without imposing special requirements or modifiers for 340B drugs. The law also protects patients' choice to receive 340B drugs from participating providers without interference. Violations are treated as unfair trade practices under Massachusetts law, enforced by the Attorney General and pharmacy board. The bill directly affects 340B program participants, their pharmacy partners, insurers, and drug manufacturers/distributors operating in Massachusetts.
This bill requires pharmacy benefits managers (PBMs) to obtain a license from the Massachusetts insurance commissioner before providing drug pricing services. It establishes rules for how PBMs set reimbursement rates for prescription drugs ("Maximum Allowable Cost" or MAC), requiring them to update these rates every 7 days and base them on FDA-approved drug lists. PBMs must also provide transparent pricing information to hospitals and insurers about the difference between what they pay pharmacies and what they bill covered entities. Pharmacies can appeal low reimbursement rates under a standardized process, and PBMs must respond to appeals within 10 business days. The law directly affects PBMs, hospitals, insurers, and employers offering health coverage in Massachusetts.
This bill requires health insurance plans in Massachusetts covering prescription drugs to establish a separate out-of-pocket limit for those drugs - including specialty drugs - distinct from other medical costs. The limit cannot exceed the federal minimum annual deductible for high-deductible health plans (set under IRS code 26 U.S.C. §223), which covers both self-only and family coverage. It defines "out-of-pocket limit" to include cost-sharing expenses like copays under the Affordable Care Act. The rule applies to all relevant health insurance policies renewed or issued on or after January 1, 2026, directly affecting insurers and patients with prescription drug coverage.
This bill protects 340B providers - like community health centers and safety-net hospitals that participate in the federal 340B drug discount program - from unfair practices by pharmacy benefit managers (PBMs). It prohibits PBMs from reimbursing these providers at lower rates than non-340B entities, charging extra fees for 340B participation, restricting network access based on 340B status, or requiring special drug identifiers. The bill also bans PBMs from imposing higher patient copays or steering patients away from 340B providers. These changes ensure 340B providers can operate fairly and patients can access discounted medications without additional barriers.
This bill prohibits pharmacy benefit managers (PBMs) from discriminating against hospitals and clinics participating in the federal 340B drug discount program. It specifically bans PBMs from paying lower rates for 340B drugs than non-340B drugs, charging extra fees for 340B participation, restricting network access based on 340B status, or imposing higher patient costs (like extra copays) when using 340B providers. The law directly affects safety-net hospitals, clinics, and their patients who rely on the 340B program to access discounted medications. It ensures these providers aren’t penalized for participating in the federal program through PBM billing practices.
Bill H 4489 requires pharmaceutical manufacturers to disclose pricing information - including wholesale cost trends, research spending, and explanations for price changes - to a state commission. The commission reviews this data to assess whether drug pricing is unreasonable compared to a "proposed value" and then issues public recommendations, such as bulk purchasing programs or adjusted insurance costs, to improve affordability. Manufacturers face potential civil penalties of up to $500,000 for non-compliance or providing false information. The bill explicitly states its process does not affect individual patient treatment decisions or health plan coverage determinations.
This bill prohibits pharmacy benefit managers (PBMs) from charging fees tied to drug prices, rebates, or patient costs. It bans "spread pricing" (where PBMs pocket the difference between what they pay pharmacies and what they charge insurers) and requires PBMs to charge only a fixed fee for services. The law directly affects PBMs, health insurers (carriers), and unaffiliated pharmacies, ensuring PBMs operate transparently with fees based solely on services provided. PBMs must annually certify compliance with these rules to the state insurance commissioner.
This bill establishes a licensing system for specialty pharmacies in Massachusetts that dispense complex medications (like those for cancer or autoimmune conditions). It requires these pharmacies to designate a lead pharmacist who must register with the state, maintain detailed records of dispensed drugs, and report changes annually or after updates. Insurance companies must allow any licensed pharmacy to provide specialty drugs under the same payment terms and cannot block access to these medications. The law directly affects specialty pharmacies (including out-of-state providers needing a license), pharmacists in charge, and insurers, ensuring consistent access to specialty medications within Massachusetts.
