By Mr. Tarr, a petition (accompanied by bill, Senate, No. 831) of Bruce E. Tarr for legislation to ensure access to prescription medication and community pharmacies. Financial Services.
By Mr. Montigny, a petition (accompanied by bill, Senate, No. 895) of Mark C. Montigny for legislation to promote transparency and prevent price gouging of pharmaceutical drug prices. Health Care Financing.
This bill protects 340B providers - like community health centers and safety-net hospitals that participate in the federal 340B drug discount program - from unfair practices by pharmacy benefit managers (PBMs). It prohibits PBMs from reimbursing these providers at lower rates than non-340B entities, charging extra fees for 340B participation, restricting network access based on 340B status, or requiring special drug identifiers. The bill also bans PBMs from imposing higher patient copays or steering patients away from 340B providers. These changes ensure 340B providers can operate fairly and patients can access discounted medications without additional barriers.
This bill establishes licensing requirements for specialty pharmacies in Massachusetts that dispense specialty medications. It requires these pharmacies to designate a registered pharmacist in charge who must maintain good standing with their licensing board, submit annual reports, and keep detailed records of all drugs dispensed. The law also prohibits out-of-state pharmacies from dispensing specialty medications in Massachusetts without obtaining a specialty license. Additionally, it mandates that insurance carriers cannot block access to specialty drugs dispensed by licensed pharmacies that meet required handling and monitoring standards.
H 4496 requires health insurance plans covering prescriptions to allow partial medication fills at a pro-rated daily cost when a doctor or pharmacist determines it benefits the patient and the patient agrees. It prohibits insurers from denying coverage for partial fills used to synchronize multiple prescriptions (e.g., aligning refill dates for several medications). The bill also mandates full payment for dispensing fees on partial fills and blocks insurers from using pro-rated dispensing fees. This directly affects patients needing medication synchronization, pharmacists, prescribers, and health insurance plans in Massachusetts.
This bill allows pharmacists in Massachusetts to provide emergency insulin without a current prescription during urgent situations where a patient cannot quickly obtain authorization from their doctor. It defines an "emergency situation" as one where immediate prescription authorization isn't possible and requires pharmacists to use their professional judgment to determine if insulin is essential for sustaining life or managing a chronic condition. The bill limits emergency insulin dispensing to a 30-day supply per instance and prohibits the same pharmacist from providing this emergency supply more than once every six months to the same patient. It amends multiple statutes to include this provision, ensuring pharmacists can act in emergencies while maintaining safety safeguards.
By Representative McMurtry of Dedham, a petition (accompanied by bill, House, No. 1390) of Paul McMurtry relative to MassHealth managed care pharmacy benefit reimbursement rates. Health Care Financing.
This bill (HD 870) requires Massachusetts Medicaid providers to be reimbursed for administering vaccines at rates no lower than the federal Centers for Medicare & Medicaid Services (CMS) regional rates, starting January 1, 2026. It directly affects all providers (including pharmacies via pharmacy benefit managers) who give immunizations to Medicaid-eligible adults and children in Massachusetts. The key provision mandates that reimbursement rates for vaccine administration must match or exceed CMS rates, ensuring providers aren't paid less than federal standards. This change applies to all Medicaid-eligible immunizations covered under the state's program.
HD 896 requires Massachusetts' Office of Health Resource Planning to assess pharmacy access across the state, specifically identifying "pharmacy deserts" defined as areas with limited access due to geographic distance (e.g., >1 mile in urban areas), excessive travel time (15+ min by car, 30+ min by transit), or transportation barriers. The office must analyze the impact of these deserts on medication access, health outcomes, healthcare costs (including ER visits), and pharmacy closures, while identifying affected neighborhoods and populations. By September 1, 2026, the office must submit a detailed report to state legislative committees and health agencies, including policy recommendations to address existing deserts and prevent new ones. This bill is procedural, focusing on data collection and analysis to inform future policy decisions, not on immediate regulatory changes.
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.
