This bill requires pharmacy benefits managers (PBMs) and insurers to maintain transparent "maximum allowable cost" lists for drugs, ensuring these lists only include therapeutically equivalent generic drugs with multiple available sources. It mandates that PBMs update reimbursement rates at least every 3 business days to cover actual pharmacy acquisition costs and provides pharmacies a 7-day appeal process if rates are unfairly low. Pharmacies can contest rates based on market prices or improper listing, with PBMs required to resolve appeals within 7 days and adjust rates for all similar pharmacies if an appeal succeeds. The Insurance Commissioner enforces these rules, including auditing PBMs and protecting confidential compliance data from public disclosure.
HD 2359 requires pharmacy benefits managers (PBMs) and health insurers to set maximum allowable costs for prescription drugs based on FDA ratings and the availability of equivalent drugs, ensuring these costs cover pharmacies' actual acquisition costs. The bill mandates transparency by requiring PBMs to share cost calculation details, updated cost lists (every 3 business days), and a clear appeals process for pharmacies to contest low reimbursement rates within 7 days. It prohibits retroactive discounts and ensures non-affiliated pharmacies receive equal reimbursement rates as affiliated ones. This law directly affects PBMs and insurers, aiming to improve pharmacy reimbursement and access to medications.
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.
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.
HD 2247 prohibits health insurance companies and pharmacy benefit managers from including "gag clauses" in contracts with pharmacies. These clauses previously blocked pharmacists from telling patients about the actual cost of medications or cheaper alternatives, like paying cash. The bill requires pharmacists to share cost information and alternative purchasing options without penalty. Additionally, it ensures patients pay no more at the pharmacy than they would if paying cash for the medication without insurance.
This bill allows pharmacists in Massachusetts to test for, screen, and initiate treatment for specific health conditions - including Influenza, Streptococcal infections, COVID-19, and HIV (including PrEP/PEP) - under a statewide protocol established by the Board of Pharmacy. It directly affects pharmacists (expanding their clinical role) and patients seeking accessible testing and initial treatment for these conditions. Key provisions require pharmacists to follow the protocol, delegate administrative tasks to technicians under supervision, and refer high-risk patients for hospital care when needed. The bill also mandates insurance companies to reimburse pharmacists for these services at standard rates for other healthcare providers, ensuring fair compensation.
This bill allows certified pharmacists in Massachusetts to test for, screen, and initiate treatment for specific health conditions - including influenza, strep infections, COVID-19, HIV (including PrEP/PEP), and others approved by the pharmacy board - under a statewide protocol. Pharmacists may delegate administrative tasks to pharmacy technicians and use CLIA-waived tests, with specific guidance for positive COVID-19 cases requiring patient advice and reporting. The law mandates that insurance companies reimburse pharmacists at standard rates for these services, prohibiting denial of coverage for certified pharmacists providing these treatments within their scope. It directly affects pharmacists, patients seeking these services, and healthcare insurers across the state.
By Mr. Eldridge, a petition (accompanied by bill, Senate, No. 734) of James B. Eldridge for legislation to ensure access to medications. Financial Services.
By Mr. Kennedy, a petition (accompanied by bill, Senate, No. 875) of Edward J. Kennedy for legislation to promote transparency in prescription drug prices by conducting an affordability review of prescription drugs. Health Care Financing.
This bill expands pharmacists' role in healthcare by allowing them to diagnose, test for, and treat specific illnesses like influenza, strep infections, and public health threats (including COVID-19) under state guidelines. Pharmacists must follow department-established procedures and can use federally waived tests or standardized screening protocols. Crucially, the bill requires insurance companies to reimburse pharmacists the same as physicians or nurses for these services, mandating new billing codes to ensure fair payment. It directly affects pharmacists, patients seeking care for these conditions, and health insurers.
