This bill amends several sections of the General Laws in Chapter 27-29.1, titled "Pharmacy Freedom of Choice - Fair Competition and Practices," to enhance the regulation of pharmacy benefit managers (PBMs) and their operations. Key changes include the introduction of new definitions, such as "health insurance commissioner," "spread pricing," and "pharmacy benefit management services," which clarify the roles and responsibilities of PBMs.

The bill establishes a duty of care and good faith for PBMs towards covered individuals and pharmacies, ensuring that they act with professionalism and transparency. It mandates that PBMs disclose financial information, including any pricing discounts, rebates, and potential conflicts of interest, to insurers.

Additionally, the bill outlines specific regulations regarding the operations of PBMs, including prohibiting them from substituting prescriptions without prescriber approval and ensuring that they do not penalize pharmacists for disclosing medication costs to patients. It requires PBMs to implement a reasonable appeals process for pricing disputes related to multi-source generic drugs, including specific timelines and communication requirements.

The enforcement costs associated with these regulations will be shared equally between PBMs and insurers. The act is set to take effect on January 1, 2027, and aims to improve accountability and transparency in pharmacy benefit management practices.