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) regarding the creation and management of maximum allowable cost (MAC) lists for drugs and medical products. 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 transparency by sharing the sources used to determine MACs and the ability for pharmacies to contest costs through a defined appeals process.

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 compliance with the new regulations and prohibits retroactive discounts by PBMs. The bill ensures that pharmacists are not restricted from sharing important healthcare information with patients, including the availability of more affordable alternatives, thereby promoting informed decision-making in medication management.

Statutes affected:
Bill Text: 118E-9B