Massachusetts 2023-2024 Regular Session

Massachusetts House Bill H1247

Introduced

2/16/23

Refer

2/16/23

Caption

Relative to pharmacy benefit managers reimbursements to pharmacies in the Commonwealth

Impact

If enacted, H1247 would significantly alter the operational landscape for pharmacy benefit managers by mandating clearer guidelines on reimbursement rates and the processes for pharmacies to challenge pricing decisions. The bill stipulates that when a PBM sets a drug price on its MAC list, it must provide access to this list and also ensure adjustments are made in line with cost increases. This is intended to protect pharmacies from being reimbursed less than what they pay for drugs, which could help local pharmacies remain viable and continue serving their communities.

Summary

House Bill 1247 addresses the issue of pharmacy benefit managers (PBMs) and their reimbursement practices towards pharmacies within the Commonwealth of Massachusetts. The bill introduces an amendment to Chapter 176D of the General Laws, which sets forth a new section regarding the responsibilities of PBMs, particularly concerning the establishment and adjustment of maximum allowable cost (MAC) lists for drugs. This aims to ensure pharmacies are reimbursed at rates that do not fall below their acquisition costs, thereby promoting fairer pricing practices in the health care sector.

Contention

Debates surrounding H1247 are likely to include discussions on the balance of power between pharmacy benefit managers and pharmacies. Supporters of the bill argue that it is necessary to prevent unfair pricing practices that could jeopardize pharmacies, particularly independent ones. However, detractors, including some PBMs and insurance companies, may argue that such regulations could lead to increased drug costs for consumers and possibly limit the ability of PBMs to negotiate lower prices for medications, which could affect overall health care costs. The legislative discourse will need to weigh the benefits of supporting local pharmacies against broader market efficiencies and consumer access to affordable medications.