The bill aims to enhance access to prescription medications by amending Chapter 176D of the General Laws. It introduces a new section, 3C, which establishes guidelines for pharmacy benefits managers (PBMs) and covered entities regarding the creation and management of maximum allowable cost (MAC) lists for drugs, medical products, and devices. Key provisions include requirements for drugs to be rated as "A" or "AB" in the FDA's Orange Book before being placed on a MAC list, the obligation to remove drugs that no longer meet these criteria within three business days, and the necessity for PBMs to ensure that the MAC is equal to or greater than the pharmacies' acquisition cost. Additionally, the bill mandates that PBMs provide pharmacies with information on the sources used to determine MACs and establish a clear process for pharmacies to contest drug costs.

Furthermore, the bill amends Section 9B of Chapter 118E, requiring MassHealth Managed Care Organizations and Accountable Care Organizations to reimburse pharmacies at rates specified in the MassHealth Pharmacy Provider Manual. It also empowers the Insurance Commissioner to enforce the act and conduct audits to ensure compliance. The bill prohibits retroactive discounts by PBMs and ensures that pharmacies are not restricted from disclosing relevant healthcare information to patients. Overall, the legislation seeks to promote transparency and fairness in the pricing and reimbursement processes for prescription medications.

Statutes affected:
Bill Text: 118E-9B