An Act to ensure access to prescription medication and community pharmacies
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Progress
Where this bill stands in the legislative process.
- Introduced
- Passed House
- Passed Senate
- To Governor
- Became Law
Overview
This bill aims to improve access to prescription medications and support community pharmacies in Massachusetts. It establishes rules for pharmacy benefit managers (PBMs) regarding payment practices, cost controls, and network pharmacy participation. The bill seeks to ensure fair reimbursement rates for pharmacies and prevent PBMs from steering patients towards specific pharmacies, particularly those affiliated with the PBM. It also includes provisions for transparency in pricing and appeals processes.
Key provisions
- Establishes minimum payment rates for pharmacy services, aligning them with the Massachusetts Medicaid Program.
- Prohibits pharmacy steering by PBMs, preventing them from directing patients to preferred pharmacies.
- Requires PBMs to provide pharmacies with detailed information about the sources used to determine maximum allowable costs.
- Creates a process for pharmacies to appeal cost determinations and ensures retroactive adjustments if an appeal is successful.
- Sets maximum allowable costs for drugs, based on FDA ratings and availability of generic alternatives.
- Prohibits PBMs from charging community pharmacies for credentialing.
- Requires PBMs to report denied pharmacy appeals annually.
- Allows pharmacies to use signature logs to validate prescription intent during audits.
Who is affected
- Community Pharmacies
- Pharmacy Benefit Managers (PBMs)
Bill text
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Sponsors
Official sponsors from legislative records.
3 on record
Primary sponsor
Joint Committee on Financial Services
Cosponsors
Patrick Joseph Kearney
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