Massachusetts 2023-2024 Regular Session

Massachusetts House Bill H945 Compare Versions

Only one version of the bill is available at this time.

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2	2	HOUSE DOCKET, NO. 2503 FILED ON: 1/19/2023
3	3	HOUSE . . . . . . . . . . . . . . . No. 945
4	4	The Commonwealth of Massachusetts
5	5	_________________
6	6	PRESENTED BY:
7	7	Christine P. Barber and Jon Santiago
8	8	_________________
9	9	To the Honorable Senate and House of Representatives of the Commonwealth of Massachusetts in General
10	10	Court assembled:
11	11	The undersigned legislators and/or citizens respectfully petition for the adoption of the accompanying bill:
12	12	An Act to ensure prescription drug cost transparency and affordability.
13	13	_______________
14	14	PETITION OF:
15	15	NAME:DISTRICT/ADDRESS :DATE ADDED:Christine P. Barber34th Middlesex1/19/2023Jon Santiago9th Suffolk1/19/2023Lindsay N. Sabadosa1st Hampshire1/19/2023Mindy Domb3rd Hampshire1/19/2023Carmine Lawrence Gentile13th Middlesex1/25/2023David Paul Linsky5th Middlesex1/26/2023Lenny Mirra2nd Essex1/26/2023Peter Capano11th Essex1/27/2023Susannah M. Whipps2nd Franklin1/27/2023Brian W. Murray10th Worcester1/29/2023Jack Patrick Lewis7th Middlesex2/1/2023Vanna Howard17th Middlesex2/1/2023Patricia A. Duffy5th Hampden2/2/2023Kevin G. Honan17th Suffolk2/3/2023Jennifer Balinsky Armini8th Essex2/4/2023David Henry Argosky LeBoeuf17th Worcester2/6/2023Jason M. LewisFifth Middlesex2/7/2023Patrick M. O'ConnorFirst Plymouth and Norfolk2/8/2023 2 of 2
16	16	Colleen M. Garry36th Middlesex2/13/2023James C. Arena-DeRosa8th Middlesex2/13/2023James B. EldridgeMiddlesex and Worcester2/16/2023Kate Lipper-Garabedian32nd Middlesex2/22/2023Natalie M. Higgins4th Worcester2/23/2023Tram T. Nguyen18th Essex2/27/2023 1 of 29
17	17	HOUSE DOCKET, NO. 2503 FILED ON: 1/19/2023
18	18	HOUSE . . . . . . . . . . . . . . . No. 945
19	19	By Representatives Barber of Somerville and Santiago of Boston, a petition (accompanied by
20	20	bill, House, No. 945) of Christine P. Barber, Jon Santiago and others for legislation to ensure
21	21	prescription drug cost transparency and affordability. Financial Services.
22	22	The Commonwealth of Massachusetts
23	23	_______________
24	24	In the One Hundred and Ninety-Third General Court
25	25	(2023-2024)
26	26	_______________
27	27	An Act to ensure prescription drug cost transparency and affordability.
28	28	Be it enacted by the Senate and House of Representatives in General Court assembled, and by the authority
29	29	of the same, as follows:
30	30	1 SECTION 1. Section 1 of chapter 6D of the General Laws, as appearing so appearing, is
31	31	2hereby amended by inserting after the definition of “Alternative payment methodologies or
32	32	3methods” the following 2 definitions:-
33	33	4 “Biosimilar”, a drug that is produced or distributed pursuant to a biologics license
34	34	5application approved under 42 U.S.C. 262(k)(3).
35	35	6 “Brand name drug”, a drug that is: (i) produced or distributed pursuant to an original new
36	36	7drug application approved under 21 U.S.C. 355(c) except for an authorized generic as defined by
37	37	842 C.F.R. 447.502; (ii) produced or distributed pursuant to a biologics license application
38	38	9approved under 42 U.S.C. 262(a)(2)(C); or (iii) identified by the health benefit plan as a brand
39	39	10name drug based on available data resources such as Medi-Span.
40	40	11 SECTION 2. Said section 1 of said chapter 6D, as so appearing, is hereby further
41	41	12amended by inserting after the definition of “Fiscal year” the following definition:- 2 of 29
42	42	13 “Generic drug”, a retail drug that is: (i) marketed or distributed pursuant to an
43	43	14abbreviated new drug application approved under 21 U.S.C. 355(j); (ii) an authorized generic as
44	44	15defined by 42 C.F.R. 447.502; (iii) a drug that entered the market before January 1, 1962 and
45	45	16was not originally marketed under a new drug application; or (iv) identified by the health benefit
46	46	17plan as a generic drug based on available data resources such as Medi-Span.
47	47	18 SECTION 3. Said section 1 of said chapter 6D, as so appearing, is hereby further
48	48	19amended by striking out, in line 189, the words “not include excludes ERISA plans” and
49	49	20inserting in place thereof the following words:- include self-insured plans to the extent allowed
50	50	21under the federal Employee Retirement Income Security Act of 1974.
51	51	22 SECTION 4. Said section 1 of said chapter 6D, as so appearing, is hereby further
52	52	23amended by inserting after the definition of “Performance penalty” the following 2 definitions:-
53	53	24 “Pharmaceutical manufacturing company”, an entity engaged in the: (i) production,
54	54	25preparation, propagation, compounding, conversion or processing of prescription drugs, directly
55	55	26or indirectly, by extraction from substances of natural origin, independently by means of
56	56	27chemical synthesis or by a combination of extraction and chemical synthesis; or (ii) packaging,
57	57	28repackaging, labeling, relabeling or distribution of prescription drugs; provided, however, that
58	58	29“pharmaceutical manufacturing company” shall not include a wholesale drug distributor licensed
59	59	30under section 36B of chapter 112 or a retail pharmacist registered under section 39 of said
60	60	31chapter 112.
61	61	32 “Pharmacy benefit manager”, a person, business or other entity, however organized, that
62	62	33directly or through a subsidiary provides pharmacy benefit management services for prescription
63	63	34drugs and devices on behalf of a health benefit plan sponsor, including, but not limited to, a self- 3 of 29
64	64	35insurance plan, labor union or other third-party payer; provided, however, that pharmacy benefit
65	65	36management services shall include, but not be limited to, the processing and payment of claims
66	66	37for prescription drugs, the performance of drug utilization review, the processing of drug prior
67	67	38authorization requests, pharmacy contracting, the adjudication of appeals or grievances related to
68	68	39prescription drug coverage contracts, formulary administration, drug benefit design, mail and
69	69	40specialty drug pharmacy services, cost containment, clinical, safety and adherence programs for
70	70	41pharmacy services and managing the cost of covered prescription drugs; provided further, that
71	71	42“pharmacy benefit manager” shall include a health benefit plan that does not contract with a
72	72	43pharmacy benefit manager and manages its own prescription drug benefits unless specifically
73	73	44exempted by the commission.
74	74	45 SECTION 5. Said section 1 of said chapter 6D, as so appearing, is hereby further
75	75	46amended by adding the following definition:-
76	76	47 “Wholesale acquisition cost”, shall have the same meaning as defined in 42 U.S.C.
77	77	481395w-3a(c)(6)(B).
78	78	49 SECTION 6. Said chapter 6D is hereby further amended by striking out section 2A, as so
79	79	50appearing, and inserting in place thereof the following section:-
80	80	51 Section 2A. The commission shall keep confidential all nonpublic clinical, financial,
81	81	52strategic or operational documents or information provided or reported to the commission in
82	82	53connection with any care delivery, quality improvement process, performance improvement plan
83	83	54authorized under sections 7, 10, 14, 15 or 20 of this chapter or under section 2GGGG of chapter
84	84	5529 and shall not disclose the information or documents to any person without the consent of the
85	85	56payer, provider or pharmaceutical manufacturing company providing or reporting the 4 of 29
86	86	57information or documents under said sections 7, 10, 14, 15, or 20 of this chapter or under said
87	87	58section 2GGGG of said chapter 29, except in summary form in evaluative reports of such
88	88	59activities or when the commission believes that such disclosure should be made in the public
89	89	60interest after taking into account any privacy, trade secret or anticompetitive considerations. The
90	90	61confidential information and documents shall not be public records and shall be exempt from
91	91	62disclosure under clause Twenty sixth of section 7 of chapter 4 or section 10 of chapter 66.
92	92	63 SECTION 7. Section 6 of said chapter 6D, as so appearing, is hereby amended by
93	93	64inserting after the word “center”, in line 1, the following words:- , pharmaceutical and
94	94	65biopharmaceutical manufacturing company, pharmacy benefit manager.
95	95	66 SECTION 8. Said section 6 of said chapter 6D, as so appearing, is hereby further
96	96	67amended by striking out, in lines 5 and 36, the figure “33” and inserting in place thereof, in each
97	97	68instance, the following figure:- 25.
98	98	69 SECTION 9. Said section 6 of said chapter 6D, as so appearing, is hereby further
99	99	70amended by adding the following paragraph:-
100	100	71 The assessed amount for pharmaceutical and biopharmaceutical manufacturing
101	101	72companies and pharmacy benefit managers shall be not less than 25 per cent of the amount
102	102	73appropriated by the general court for the expenses of the commission minus amounts collected
103	103	74from: (i) filing fees; (ii) fees and charges generated by the commission's publication or
104	104	75dissemination of reports and information; and (iii) federal matching revenues received for these
105	105	76expenses or received retroactively for expenses of predecessor agencies. Pharmaceutical and
106	106	77biopharmaceutical manufacturing companies and pharmacy benefit managers shall, in a manner
107	107	78and distribution determined by the commission, pay to the commonwealth an amount of the 5 of 29
108	108	79estimated expenses of the commission attributable to the commission’s activities under sections
109	109	808, 9 and 20. A pharmacy benefit manager that is a surcharge payor subject to the preceding
110	110	81paragraph and manages its own prescription drug benefits shall not be subject to additional
111	111	82assessment under this paragraph.
112	112	83 SECTION 10. Section 8 of said chapter 6D, as so appearing, is hereby amended by
113	113	84inserting after the word “organization”, in lines 6 and 7, the following words:- , pharmacy benefit
114	114	85manager, pharmaceutical manufacturing company.
115	115	86 SECTION 11. Said section 8 of said chapter 6D, as so appearing, is hereby further
116	116	87amended by inserting after the word “organizations”, in line 14, the following words:- ,
117	117	88pharmacy benefit managers, pharmaceutical manufacturing companies.
118	118	89 SECTION 12. Said section 8 of said chapter 6D, as so appearing, is hereby further
119	119	90amended by striking out, in line 32, the words “and (xi)” and inserting in place thereof the
120	120	91following words:- (xi) at least 3 representatives of the pharmaceutical industry; (xii) at least 1
121	121	92pharmacy benefit manager; and (xiii).
122	122	93 SECTION 13. Said section 8 of said chapter 6D, as so appearing, is hereby further
123	123	94amended by inserting after the word “commission”, in line 59, the first time it appears, the
124	124	95following words:- ; and (iii) in the case of pharmacy benefit managers and pharmaceutical
125	125	96manufacturing companies, testimony concerning factors underlying prescription drug costs and
126	126	97price increases including, but not limited to, the initial prices of drugs coming to market and
127	127	98subsequent price increases, changes in industry profit levels, marketing expenses, reverse
128	128	99payment patent settlements, the impact of manufacturer rebates, discounts and other price 6 of 29
129	129	100concessions on net pricing, the availability of alternative drugs or treatments and any other
130	130	101matters as determined by the commission.
131	131	102 SECTION 14. Subsection (g) of said section 8 of said chapter 6D, as so appearing, is
132	132	103hereby amended by striking out the second sentence and inserting in place thereof the following
133	133	104sentence:- The report shall be based on the commission’s analysis of information provided at the
134	134	105hearings by witnesses, providers, provider organizations, payers, pharmaceutical manufacturing
135	135	106companies and pharmacy benefit managers, registration data collected under section 11, data
136	136	107collected or analyzed by the center under sections 8, 9, 10, and 10A of chapter 12C and any other
137	137	108available information that the commission considers necessary to fulfill its duties under this
138	138	109section as defined in regulations promulgated by the commission.
139	139	110 SECTION 15. Section 9 of said chapter 6D, as so appearing, is hereby amended by
140	140	111inserting after the word “organization”, in line 72, the following words:- , pharmacy benefit
141	141	112manager, pharmaceutical manufacturing company.
142	142	113 SECTION 16. Said chapter 6D, as so appearing, is hereby further amended by adding the
143	143	114following section:
144	144	115 Section 20. (a) For the purposes of this section, “Manufacturer” shall mean an entity that
145	145	116manufactures a pharmaceutical drug.
146	146	117 (b) The commission may require a manufacturer specified in subsection (c) to disclose to
147	147	118the commission within a reasonable time information relating to the manufacturer’s pricing of
148	148	119that drug, on a standard reporting form developed by the commission with the input of the
149	149	120manufacturers, which includes, but shall not be limited to, the following: 7 of 29
150	150	121 (1) A schedule of the drug’s wholesale acquisition cost increases over the previous 5
151	151	122calendar years;
152	152	123 (2) The manufacturer’s aggregate, company-level research and development and other
153	153	124relevant capital expenditures, including facility construction, for the most recent year for which
154	154	125final audited data are available;
155	155	126 (3) A written, narrative description, suitable for public release, of factors that contributed
156	156	127to reported changes in wholesale acquisition cost during the previous 5 calendar years; and
157	157	128 (4) Any other information that the manufacturer wishes to provide to the commission.
158	158	129 Based on the records furnished, the commission may identify a proposed value for a
159	159	130prescribed drug specified in subsection (c). The Commission may request additional relevant
160	160	131information that it deems necessary.
161	161	132 (c) A manufacturer of a drug for which the commission has received a referral from the
162	162	133center under subsection (b) of section 25 of chapter 12C shall comply with the requirements set
163	163	134forth in this section; provided that the commission may select or prioritize a subset of the
164	164	135referred drugs for the commission’s review.
165	165	136 (d) Records disclosed by a manufacturer under this section shall: (i) be accompanied by
166	166	137an attestation that all information provided is true and correct; (ii) not be public records under
167	167	138section 7 of chapter 4 or chapter 66; and (iii) remain confidential; provided, however, that the
168	168	139commission may produce reports summarizing any findings; provided that any such report shall
169	169	140not be in a form that identifies specific prices charged for or rebate amounts associated with 8 of 29
170	170	141drugs by a manufacturer, or in a manner that is likely to compromise the financial, competitive or
171	171	142proprietary nature of the information.
172	172	143 (e) If, after review of any records furnished to the commission under subsection (b), the
173	173	144commission determines that the manufacturer’s pricing of the drug is potentially unreasonable or
174	174	145excessive in relation to the commission’s proposed value under subsection (b), the commission
175	175	146shall require that the manufacturer provide within 30 days further information related to the
176	176	147pricing of the prescribed drug and the manufacturer’s justification for the pricing. In addition to
177	177	148the manufacturer, the commission may identify other relevant parties including but not limited to
178	178	149patients, providers, provider organizations and payers who may provide information to the
179	179	150commission.
180	180	151 (f) The commission shall provide to the manufacturer for review and input any
181	181	152information, analyses or reports regarding a particular drug reviewed or relied on by the
182	182	153commission in assessing the proposed value of the drug shall be provided to the manufacturer.
183	183	154The commission shall consider any clarifications or data provided by the manufacturer with
184	184	155respect to its drug. The commission may not rely solely on the analysis or research of an outside
185	185	156third party in reaching its determination regarding the proposed value or the reasonableness of
186	186	157the drug pricing.
187	187	158 (g) If the commission relies upon a third party to provide cost-effectiveness analysis or
188	188	159research related to the proposed value, such analysis or research shall also provide, without
189	189	160limitation (i) a description of the methodologies and models used by the third party in its
190	190	161analysis; (ii) any assumptions and potential limitations of research findings in the context of the
191	191	162results; and (iii) outcomes for affected subpopulations that utilize the drug, including but not 9 of 29
192	192	163limited to potential impacts on individuals of minority racial or ethnic groups, and on individuals
193	193	164with specific disabilities or health conditions who regularly utilize the eligible drug.
194	194	165 (h) Not later than 60 days after receiving information from the manufacturer, as required
195	195	166under subsections (b) or (e), the commission shall issue a determination on whether the
196	196	167manufacturer’s pricing of a drug is unreasonable or excessive in relation to the commission’s
197	197	168proposed value of the drug. Following the determination, the commission shall issue
198	198	169recommendations on measures to reduce the cost of the drug and to improve the affordability of
199	199	170the drug for patients. Recommendations may include, but not be limited to: (i) an alternative
200	200	171purchasing plan or value-based payment methodology; (ii) a bulk purchasing program; (iii)
201	201	172changes to co-pay, deductibles, coinsurance or other cost-sharing requirements; or (iv) a
202	202	173reinsurance program to subsidize the cost of the eligible drug. The commission shall make its
203	203	174determination and recommendations public and shall post them on its website and shall provide
204	204	175them to private and public health care payers.
205	205	176 (i) If the manufacturer fails to timely comply with the commission’s request for records
206	206	177under subsections (b) or (e), or otherwise knowingly obstructs the commission’s ability to issue
207	207	178its determination under subsection (h), including, but not limited to, providing incomplete, false
208	208	179or misleading information, the commission may assess a civil penalty to a manufacturer of not
209	209	180more than $500,000. A civil penalty assessed under this subsection shall be deposited into the
210	210	181Payment Reform Fund established pursuant to section 100 of chapter 194 of the acts of 2011.
211	211	182The commission shall seek to promote compliance with this section and shall only impose a civil
212	212	183penalty on the manufacturer as a last resort. 10 of 29
213	213	184 (j) Neither the proposed value, nor the analysis produced via the process to determine a
214	214	185proposed value, is intended to be used by MassHealth, health insurance carriers, managed care
215	215	186organizations, accountable care organizations, hospitals or pharmacies to determine whether a
216	216	187treatment should be approved for an individual patient, whether any individual patient should be
217	217	188subjected to step therapy or other utilization management methodology,
218	218	189 (k) The commission shall adopt any written policies, procedures or regulations that the
219	219	190commission determines necessary to implement this section.
220	220	191 SECTION 17. Section 11N of chapter 12 of the General Laws, as so appearing, is hereby
221	221	192amended by striking out subsection (a) and inserting in place thereof the following subsection:-
222	222	193 (a) The attorney general shall monitor trends in the health care market including, but not
223	223	194limited to, trends in provider organization size and composition, consolidation in the provider
224	224	195market, payer contracting trends, patient access and quality issues in the health care market and
225	225	196prescription drug cost trends. The attorney general may obtain the following information from a
226	226	197private health care payer, public health care payer, pharmaceutical manufacturing company,
227	227	198pharmacy benefit manager, provider or provider organization as any of those terms may be
228	228	199defined in section 1 of chapter 6D: (i) any information that is required to be submitted under
229	229	200sections 8, 9 10 and 10A of chapter 12C; (ii) filings, applications and supporting documentation
230	230	201related to any cost and market impact review under section 13 of said chapter 6D; (iii) filings,
231	231	202applications and supporting documentation related to a determination of need application filed
232	232	203under section 25C of chapter 111; and (iv) filings, applications and supporting documentation
233	233	204submitted to the federal Centers for Medicare and Medicaid Services or the Office of the
234	234	205Inspector General for any demonstration project. Under section 17 of said chapter 12C and 11 of 29
235	235	206section 8 of said chapter 6D and subject to the limitations stated in those sections, the attorney
236	236	207general may require that any provider, provider organization, pharmaceutical manufacturing
237	237	208company, pharmacy benefit manager, private health care payer or public health care payer
238	238	209produce documents, answer interrogatories and provide testimony under oath related to health
239	239	210care costs and cost trends, pharmaceutical costs, pharmaceutical cost trends, the factors that
240	240	211contribute to cost growth within the commonwealth's health care system and the relationship
241	241	212between provider costs and payer premium rates and the relationship between pharmaceutical
242	242	213drug costs and payer premium rates.
243	243	214 SECTION 18. Section 1 of chapter 12C of the General Laws, as so appearing, is hereby
244	244	215amended by inserting after the definition of “Ambulatory surgical center services” the following
245	245	2163 definitions:-
246	246	217 “Average manufacturer price”, the average price paid to a manufacturer for a drug in the
247	247	218commonwealth by a wholesaler for drugs distributed to pharmacies and by a pharmacy that
248	248	219purchases drugs directly from the manufacturer.
249	249	220 “Biosimilar”, a drug that is produced or distributed pursuant to a biologics license
250	250	221application approved under 42 U.S.C. 262(k)(3).
251	251	222 “Brand name drug”, a drug that is: (i) produced or distributed pursuant to an original new
252	252	223drug application approved under 21 U.S.C. §355(c) except for an authorized generic as defined
253	253	224by 42 C.F.R. § 447.502; (ii) produced or distributed pursuant to a biologics license application
254	254	225approved under 42 U.S.C. § 262(a)(2)(C); or (iii) identified by the health benefit plan as a brand
255	255	226name drug based on available data resources such as Medi-Span. 12 of 29
256	256	227 SECTION 19. Said section 1 of said chapter 12C, as so appearing, is hereby further
257	257	228amended by inserting after the definition of “General health supplies, care or rehabilitative
258	258	229services and accommodations” the following definition:-
259	259	230 “Generic drug”, a retail drug that is: (i) marketed or distributed pursuant to an
260	260	231abbreviated new drug application approved under 21 U.S.C. 355(j); (ii) an authorized generic as
261	261	232defined by 42 C.F.R. 447.502; (iii) a drug that entered the market before January 1, 1962 that
262	262	233was not originally marketed under a new drug application; or (iv) identified by the health benefit
263	263	234plan as a generic drug based on available data resources such as Medi-Span.
264	264	235 SECTION 20. Said section 1 of said chapter 12C, as so appearing, is hereby further
265	265	236amended by inserting after the definition of “Patient-centered medical home” the following 2
266	266	237definitions:-
267	267	238 “Pharmaceutical manufacturing company”, an entity engaged in the: (i) production,
268	268	239preparation, propagation, compounding, conversion or processing of prescription drugs, directly
269	269	240or indirectly, by extraction from substances of natural origin, independently by means of
270	270	241chemical synthesis or by a combination of extraction and chemical synthesis; or (ii) packaging,
271	271	242repackaging, labeling, relabeling or distribution of prescription drugs; provided, however, that
272	272	243“pharmaceutical manufacturing company” shall not include a wholesale drug distributor licensed
273	273	244under section 36B of chapter 112 or a retail pharmacist registered under section 39 of said
274	274	245chapter 112.
275	275	246 “Pharmacy benefit manager”, a person, business or other entity, however organized, that,
276	276	247directly or through a subsidiary, provides pharmacy benefit management services for prescription
277	277	248drugs and devices on behalf of a health benefit plan sponsor, including, but not limited to, a self- 13 of 29
278	278	249insurance plan, labor union or other third-party payer; provided, however, that pharmacy benefit
279	279	250management services shall include, but not be limited to, the processing and payment of claims
280	280	251for prescription drugs, the performance of drug utilization review, the processing of drug prior
281	281	252authorization requests, pharmacy contracting, the adjudication of appeals or grievances related to
282	282	253prescription drug coverage contracts, formulary administration, drug benefit design, mail and
283	283	254specialty drug pharmacy services, cost containment, clinical, safety and adherence programs for
284	284	255pharmacy services and managing the cost of covered prescription drugs; provided further, that
285	285	256“pharmacy benefit manager” shall include a health benefit plan that does not contract with a
286	286	257pharmacy benefit manager and manages its own prescription drug benefits unless specifically
287	287	258exempted by the commission.
288	288	259 SECTION 21. Said section 1 of said chapter 12C, as so appearing, is hereby further
289	289	260amended by adding the following definition:-
290	290	261 “Wholesale acquisition cost”, shall have the same meaning as defined in 42 U.S.C.
291	291	2621395w-3a(c)(6)(B).
292	292	263 SECTION 22. Section 3 of said chapter 12C, as so appearing, is hereby amended by
293	293	264inserting after the word “organizations”, in lines 13 and 14, the following words:- ,
294	294	265pharmaceutical manufacturing companies, pharmacy benefit managers.
295	295	266 SECTION 23. Said section 3 of said chapter 12C, as so appearing, is hereby further
296	296	267amended by striking out, in line 24, the words “and payer” and inserting in place thereof the
297	297	268following words:- , payer, pharmaceutical manufacturing company and pharmacy benefit
298	298	269manager. 14 of 29
299	299	270 SECTION 24. Section 5 of said chapter 12C, as so appearing, is hereby amended by
300	300	271striking out, in lines 11 and 12, the words “and public health care payers” and inserting in place
301	301	272thereof the following words:- , public health care payers, pharmaceutical manufacturing
302	302	273companies and pharmacy benefit managers.
303	303	274 SECTION 25. Said section 5 of said chapter 12C, as so appearing, is hereby further
304	304	275amended by striking out, in line 15, the words “and affected payers” and inserting in place
305	305	276thereof the following words:- affected payers, affected pharmaceutical manufacturing companies
306	306	277and affected pharmacy benefit managers.
307	307	278 SECTION 26. The first paragraph of section 7 of said chapter 12C, as so appearing, is
308	308	279hereby amended by adding the following sentence:-
309	309	280 Each pharmaceutical and biopharmaceutical manufacturing company and pharmacy
310	310	281benefit manager shall pay to the commonwealth an amount for the estimated expenses of the
311	311	282center and for the other purposes described in this chapter.
312	312	283 SECTION 27. Said section 7 of said chapter 12C, as so appearing, is hereby further
313	313	284amended by striking out, in lines 8 and 42, the figure “33” and inserting in place thereof, in each
314	314	285instance, the following figure:- 25.
315	315	286 SECTION 28. Said section 7 of said chapter 12C, as so appearing, is hereby further
316	316	287amended by adding the following paragraph:-
317	317	288 The assessed amount for pharmaceutical and biopharmaceutical manufacturing
318	318	289companies and pharmacy benefit managers shall be not less than 25 per cent of the amount
319	319	290appropriated by the general court for the expenses of the center minus amounts collected from: 15 of 29
320	320	291(i) filing fees; (ii) fees and charges generated by the commission's publication or dissemination
321	321	292of reports and information; and (iii) federal matching revenues received for these expenses or
322	322	293received retroactively for expenses of predecessor agencies. Pharmaceutical and
323	323	294biopharmaceutical manufacturing companies and pharmacy benefit managers shall, in a manner
324	324	295and distribution determined by the center, pay to the commonwealth an amount of the estimated
325	325	296expenses of the center attributable to the center’s activities under sections 3, 10A, 12 and 16. A
326	326	297pharmacy benefit manager that is a surcharge payor subject to the preceding paragraph and
327	327	298manages its own prescription drug benefits shall not be subject to additional assessment under
328	328	299this paragraph.
329	329	300 SECTION 29. Subsection (b) of section 10 of chapter 12C of the General Laws, as so
330	330	301appearing, is hereby amended by striking out, in line 55, the word “and”.
331	331	302 SECTION 30. Said subsection (b) of said section 10 of said chapter 12C is hereby further
332	332	303amended by adding the following words:- ; (12) information about prescription drug utilization
333	333	304and spending for all covered drugs, including for generic drugs, brand-name drugs, and specialty
334	334	305drugs provided in an outpatient setting or sold in a retail setting, including but not limited to
335	335	306information sufficient to show (i) highest utilization drugs, (ii) drugs with the greatest increases
336	336	307in utilization, (iii) drugs that are most impactful on plan spending, net of rebates, and (iv) drugs
337	337	308with the highest year-over-year price increases, net of rebates; and (13) information on claims
338	338	309and non-claims based payments to providers for the provision of primary care and behavioral
339	339	310health, including mental health and substance use disorder, services, as defined by the center. 16 of 29
340	340	311 SECTION 31. Subsection (c) of said section 10 of said chapter 12C, as so appearing, is
341	341	312hereby amended by striking out, in line 91, the words “()” and inserting in place thereof the
342	342	313following words:- (10).
343	343	314 SECTION 32. Said subsection (c) of said section 10 of said chapter 12C, as so appearing,
344	344	315is hereby further amended by striking out, in line 99, the word “and”.
345	345	316 SECTION 33. Said subsection (c) of said section 10 of said chapter 12C, as so appearing,
346	346	317is hereby further amended by adding the following words:- ; (12) information, to the extent
347	347	318permissible under 42 U.S.C. 1396r-8(b)(3)(D), about prescription drug utilization and spending
348	348	319for all covered drugs, including for generic drugs, brand-name drugs, and specialty drugs
349	349	320provided in an outpatient setting or sold in a retail setting, including but not limited to
350	350	321information sufficient to show (i) highest utilization drugs, (ii) drugs with the greatest increases
351	351	322in utilization, (iii) drugs that are most impactful on plan spending, net of rebates, and (iv) drugs
352	352	323with the highest year-over-year price increases, net of rebates; and (13) information on claims
353	353	324and non-claims based payments to providers for the provision of primary care and behavioral
354	354	325health, including mental health and substance use disorder services, as defined by the center.
355	355	326 SECTION 34. Said chapter 12C is hereby further amended by inserting after section 10
356	356	327the following section:-
357	357	328 Section 10A. (a) The center shall promulgate regulations necessary to ensure the uniform
358	358	329annual reporting of information from pharmacy benefit managers certified under chapter 175N,
359	359	330including but not limited to information on: (1) prices charged to payers on average by pharmacy
360	360	331benefits managers for select prescription drug products, net of any rebate, discounts, fees or other
361	361	332payments from the manufacturer to the pharmacy benefits manager and from the pharmacy 17 of 29
362	362	333benefits manager to the manufacturer; (2) payments received by pharmacy benefit managers by
363	363	334payers related to drugs provided to Massachusetts residents; (3) payments made by pharmacy
364	364	335benefit managers to pharmacies related to drugs provided to Massachusetts residents; (4) rebates
365	365	336received by pharmacy benefit managers from drug manufacturers related to drugs provided to
366	366	337Massachusetts residents; (5) rebates paid by pharmacy benefit managers to payers related to
367	367	338drugs provided to Massachusetts residents; (6) other payments made or received by pharmacy
368	368	339benefit managers by payers or pharmacies, including but not limited to administrative or
369	369	340performance-based payments, related to doing business in Massachusetts; (7) other rebates paid
370	370	341to or received by pharmacy benefit managers by drug manufacturers or payers related to doing
371	371	342business in Massachusetts; (8) information about prescription drug utilization and spending for
372	372	343all covered drugs, including for generic drugs, brand-name drugs, and specialty drugs provided
373	373	344in an outpatient setting or sold in a retail setting, including but not limited to information
374	374	345sufficient to show: (i) highest utilization drugs; (ii) drugs with the greatest increases in
375	375	346utilization; (iii) drugs that are most impactful on plan spending, net of rebates; and (iv) drugs
376	376	347with the highest year-over-year price increases, net of rebates; (9) the Medicare Maximum Fair
377	377	348Price (42USC Sec 1191(c)) for a prescription drug; and (10) any other information deemed
378	378	349necessary by the center.
379	379	350 (b) The center shall analyze the information and data collected under subsection (a) and
380	380	351shall publish an annual report summarizing, at minimum, the information collected under
381	381	352subsection (a) and comparing the information as it relates to each pharmacy benefit manager
382	382	353certified under chapter 175N with respect to drugs provided to Massachusetts residents. The
383	383	354center may also consult with other states collecting similar data to inform their analysis and
384	384	355annual report. 18 of 29
385	385	356 (c) Except as provided otherwise by the center or under this chapter, pharmacy benefit
386	386	357manager data collected by the center under this section shall not be a public record under clause
387	387	358Twenty-sixth of section 7 of chapter 4 or under chapter 66. The center may confidentially
388	388	359provide pharmacy benefit manager data collected by the center under this section to the health
389	389	360policy commission.
390	390	361 SECTION 35. Said chapter 12C is hereby further amended by striking out section 11, as
391	391	362so appearing, and inserting in place thereof the following section:-
392	392	363 Section 11. The center shall ensure the timely reporting of information required under
393	393	364sections 8, 9, 10 and 10A. The center shall notify payers, providers, provider organizations,
394	394	365pharmacy benefit managers and pharmaceutical manufacturing companies of any applicable
395	395	366reporting deadlines. The center shall notify, in writing, a private health care payer, provider,
396	396	367provider organization, pharmacy benefit manager or pharmaceutical manufacturing company that
397	397	368it has failed to meet a reporting deadline and that failure to respond within 2 weeks of the receipt
398	398	369of the notice may result in penalties. The center may assess a penalty against a private health care
399	399	370payer, provider, provider organization, pharmacy benefit manager or pharmaceutical
400	400	371manufacturing company that fails, without just cause, to provide the requested information
401	401	372within 2 weeks following receipt of the written notice required under this section of not more
402	402	373than $2,000 per week for each week of delay after the 2-week period following receipt of the
403	403	374written notice. Amounts collected under this section shall be deposited in the Healthcare
404	404	375Payment Reform Fund established in section 100 of chapter 194 of the acts of 2011. 19 of 29
405	405	376 SECTION 36. Section 12 of said chapter 12C, as so appearing, is hereby amended by
406	406	377striking out, in line 2, the words “and 10” and inserting in place thereof the following words:- ,
407	407	37810 and 10A.
408	408	379 SECTION 37. Subsection (a) of section 16 of said chapter 12C, as so appearing, is hereby
409	409	380amended by striking out the first sentence and inserting in place thereof the following sentence:-
410	410	381 The center shall publish an annual report based on the information submitted under: (i)
411	411	382sections 8, 9, 10 and 10A concerning health care provider, provider organization, private and
412	412	383public health care payer, pharmaceutical manufacturing company and pharmacy benefit manager
413	413	384costs and cost and price trends; (ii) section 13 of chapter 6D relative to market power reviews;
414	414	385and (iii) section 15 of said chapter 6D relative to quality data.
415	415	386 SECTION 38. Said chapter 12C is hereby further amended by striking out section 17, as
416	416	387so appearing, and inserting in place thereof the following section:-
417	417	388 Section 17. The attorney general may review and analyze any information submitted to
418	418	389the center under sections 8, 9, 10 and 10A and the health policy commission under section 8 of
419	419	390chapter 6D. The attorney general may require that any provider, provider organization,
420	420	391pharmaceutical manufacturing company, pharmacy benefit manager or payer produce
421	421	392documents, answer interrogatories and provide testimony under oath related to health care costs
422	422	393and cost trends, pharmaceutical cost trends, factors that contribute to cost growth within the
423	423	394commonwealth's health care system and the relationship between provider costs and payer
424	424	395premium rates. The attorney general shall keep confidential all nonpublic information and
425	425	396documents obtained under this section and shall not disclose the information or documents to any
426	426	397person without the consent of the provider, pharmaceutical manufacturing company, pharmacy 20 of 29
427	427	398benefit manager or payer that produced the information or documents except in a public hearing
428	428	399under said section 8 of said chapter 6D, a rate hearing before the division of insurance or in a
429	429	400case brought by the attorney general, if the attorney general believes that such disclosure will
430	430	401promote the health care cost containment goals of the commonwealth and that the disclosure
431	431	402shall be made in the public interest after taking into account any privacy, trade secret or
432	432	403anticompetitive considerations. The confidential information and documents shall not be public
433	433	404records and shall be exempt from disclosure under clause Twenty-sixth of section 7 of chapter 4
434	434	405or section 10 of chapter 66.
435	435	406 SECTION 39. Said chapter 12C is hereby further amended by adding the following
436	436	407section:-
437	437	408 Section 25. (a) The center shall analyze data on Massachusetts drug utilization and
438	438	409spending, including but not limited to data reported under Sections 10 and 10A. Annually, the
439	439	410center shall refer drugs to the health policy commission for review under section 8B of chapter
440	440	4116D that meet any of the following criteria: (i) a current average annual gross cost per utilizer for
441	441	412public and private health care payers in Massachusetts of greater than $50,000; (ii) a biosimilar
442	442	413drug that has a launch wholesale acquisition cost that is not at least 15 per cent lower than the
443	443	414referenced brand biologic at the time the biosimilar is launched; or (iii) among the 25 drugs
444	444	415determined by the center to have the most impact on health care spending in the most recent year
445	445	416of available data, based upon utilization, price, utilization and price growth, patient cost sharing
446	446	417amounts, net spending and other factors as determined by the center. The center shall provide
447	447	418notice of the referral to the manufacturer of the drug. 21 of 29
448	448	419 (b) Not later than May 1, the center shall publish an annual report detailing, at minimum,
449	449	420each drug referred to the health policy commission under subsection (a).
450	450	421 (c) The center shall adopt any written policies, procedures or regulations necessary to
451	451	422implement this section.
452	452	423 SECTION 40. Chapter 94C of the General Laws is hereby amended by inserting after
453	453	424section 21B the following section:-
454	454	425 Section 21C. (a) For the purposes of this section, the following words shall, unless the
455	455	426context clearly requires otherwise, have the following meanings:-
456	456	427 “Cost-sharing”, the amount owed by an insured under the terms of the insured’s health
457	457	428benefit plan or as required by a pharmacy benefit manager, including any copayment,
458	458	429coinsurance or deductible.
459	459	430 “Pharmacy retail price”, the amount a pharmacy bills for a prescription medication
460	460	431regardless of whether the individual purchases that prescription medication at that pharmacy
461	461	432using a health benefit plan or any other prescription medication benefit or discount.
462	462	433 “Registered pharmacist”, a pharmacist who holds a valid certificate of registration issued
463	463	434by the board of registration in pharmacy pursuant to section 24 of chapter 112.
464	464	435 (b) A health benefit plan shall (1) not restrict, directly or indirectly, any pharmacy that
465	465	436dispenses a prescription drug to an insured in the plan from informing, or penalize such
466	466	437pharmacy for informing, an insured of any differential between the insured’s cost-sharing
467	467	438amount under the plan with respect to acquisition of the drug and the amount an individual
468	468	439would pay for acquisition of the drug without using any health plan or health insurance coverage; 22 of 29
469	469	440and (2) ensure that any pharmacy benefit manager under a contract with any such health benefit
470	470	441plan does not, with respect to such plan, restrict, directly or indirectly, a pharmacy that dispenses
471	471	442a prescription drug from informing, or penalize such pharmacy for informing, an insured of any
472	472	443differential between the insured's cost-sharing amount under the plan with respect to acquisition
473	473	444of the drug and the amount an individual would pay for acquisition of the drug without using any
474	474	445health plan or health insurance coverage.
475	475	446 (c) A health benefit plan or a pharmacy benefit manager may not require an insured to
476	476	447make a payment at the point of sale for a covered prescription medication in an amount greater
477	477	448than the lesser of: (i) the applicable copayment for the prescription medication; (ii) the allowable
478	478	449claim amount for the prescription medication; (iii) the amount an insured would pay for the
479	479	450prescription medication if the insured purchased the prescription medication without using a
480	480	451health benefit plan or any other source of prescription medication benefits or discounts, to the
481	481	452extent this information is available to the health benefit plan; or (iv) the amount the pharmacy
482	482	453will be reimbursed for the drug from pharmacy benefit manager or health benefit plan.
483	483	454 (d) A pharmacy shall affirmatively inform consumers that a consumer may request, at the
484	484	455point of sale, the current pharmacy retail price for each prescription medication the consumer
485	485	456intends to purchase. The pharmacy shall provide the information through verbal indication,
486	486	457posting of a notice, or other methods. If the consumer’s cost-sharing amount for a prescription
487	487	458medication exceeds the current pharmacy retail price, the pharmacist, or an authorized individual
488	488	459at the direction of a pharmacist, shall notify the consumer that the pharmacy retail price is less
489	489	460than the patient’s cost-sharing amount. The pharmacist shall charge the consumer the applicable
490	490	461cost-sharing amount or the current pharmacy retail price for that prescription medication, as
491	491	462directed by the consumer. 23 of 29
492	492	463 (e) A contractual obligation shall not prohibit a pharmacist from complying with this
493	493	464section; provided, however, that a pharmacist shall submit a claim to the insured’s health benefit
494	494	465plan or its pharmacy benefit manager if the pharmacist has knowledge that the prescription
495	495	466medication is covered under the insured’s health benefit plan.
496	496	467 (f) A health benefit plan or pharmacy benefit manager shall not penalize, require, or
497	497	468provide financial incentives, including variations in premiums, deductibles, copayments, or
498	498	469coinsurance, to insureds as incentives to use specific retail, mail order pharmacy, or other
499	499	470network pharmacy provider in which a pharmacy benefit manager has an ownership interest or
500	500	471that has an ownership interest in a pharmacy benefit manager.
501	501	472 (g) A violation of this section shall be an unfair or deceptive act or practice under chapter
502	502	47393A.
503	503	474 SECTION 41. Section 226 of chapter 175 of the General Laws, as appearing in the 2018
504	504	475Official Edition, is hereby amended by striking out subsection (a) and inserting in place thereof
505	505	476the following subsection:-
506	506	477 (a) For the purposes of this section, the term “pharmacy benefit manager” shall mean a
507	507	478person, business or other entity, however organized, that, directly or through a subsidiary,
508	508	479provides pharmacy benefit management services for prescription drugs and devices on behalf of
509	509	480a health benefit plan sponsor, including, but not limited to, a self-insurance plan, labor union or
510	510	481other third-party payer; provided, however, that pharmacy benefit management services shall
511	511	482include, but not be limited to, the processing and payment of claims for prescription drugs, the
512	512	483performance of drug utilization review, the processing of drug prior authorization requests,
513	513	484pharmacy contracting, the adjudication of appeals or grievances related to prescription drug 24 of 29
514	514	485coverage contracts, formulary administration, drug benefit design, mail and specialty drug
515	515	486pharmacy services, cost containment, clinical, safety and adherence programs for pharmacy
516	516	487services and managing the cost of covered prescription drugs; provided further, that “pharmacy
517	517	488benefit manager” shall include a health benefit plan that does not contract with a pharmacy
518	518	489benefit manager and manages its own prescription drug benefits unless specifically exempted.
519	519	490 SECTION 42. Section 2 of Chapter 176O of the General Laws, as so appearing, is hereby
520	520	491amended by adding the following subsection:-
521	521	492 (i) At least annually, a carrier that contracts with a pharmacy benefit manager shall
522	522	493coordinate an audit of the operations of the pharmacy benefit manager to ensure compliance with
523	523	494this chapter and to examine the pricing and rebates applicable to prescription drugs that are
524	524	495provided to the carrier’s covered persons.
525	525	496 SECTION 43. Said chapter 176O of the General Laws is hereby further amended by
526	526	497inserting after section 22 the following section:-
527	527	498 Section 22A. Notwithstanding any other general or special law to the contrary, each
528	528	499carrier shall require that a pharmacy benefit manager receive a license from the division under
529	529	500chapter 176X as a condition of contracting with that carrier.
530	530	501 SECTION 44. The General Laws are hereby amended by inserting after chapter 176W
531	531	502the following chapter:-
532	532	503 Chapter 176X.
533	533	504 LICENSING AND REGULATION OF PHARMACY BENEFIT MANAGERS. 25 of 29
534	534	505 Section 1. As used in this chapter, the following words shall have the following meanings
535	535	506unless the context clearly requires otherwise:
536	536	507 “Carrier”, an insurer licensed or otherwise authorized to transact accident or health
537	537	508insurance under chapter 175, a nonprofit hospital service corporation organized under chapter
538	538	509176A, a non-profit medical service corporation organized under chapter 176B, a health
539	539	510maintenance organization organized under chapter 176G and an organization entering into a
540	540	511preferred provider arrangement under chapter 176I; provided, however, that the term “carrier”
541	541	512shall not include an employer purchasing coverage or acting on behalf of its employees or the
542	542	513employees of any subsidiary or affiliated corporation of the employer; provided further, that
543	543	514unless otherwise noted the term “carrier” shall not include any entity to the extent it offers a
544	544	515policy, certificate or contract that provides coverage solely for dental care services or vision care
545	545	516services.
546	546	517 “Center”, the center for health information and analysis established in chapter 12C.
547	547	518 “Commissioner”, the commissioner of insurance.
548	548	519 “Division”, the division of insurance.
549	549	520 “Health benefit plan”, a contract, certificate or agreement entered into, offered or issued
550	550	521by a carrier to provide, deliver, arrange for, pay for or reimburse any of the costs of health care
551	551	522services; provided, however, that the commissioner may by regulation define other health
552	552	523coverage as a health benefit plan for the purposes of this chapter. 26 of 29
553	553	524 “Pharmacy”, a physical or electronic facility under the direction or supervision of a
554	554	525registered pharmacist that is authorized to dispense prescription drugs and has entered into a
555	555	526network contract with a pharmacy benefit manager or a carrier.
556	556	527 “Pharmacy benefit manager”, a person, business or other entity, however organized, that,
557	557	528directly or through a subsidiary, provides pharmacy benefit management services for prescription
558	558	529drugs and devices on behalf of a health benefit plan sponsor, including, but not limited to, a self-
559	559	530insurance plan, labor union or other third-party payer; provided, however, that pharmacy benefit
560	560	531management services shall include, but not be limited to, the processing and payment of claims
561	561	532for prescription drugs, the performance of drug utilization review, the processing of drug prior
562	562	533authorization requests, pharmacy contracting, the adjudication of appeals or grievances related to
563	563	534prescription drug coverage contracts, formulary administration, drug benefit design, mail and
564	564	535specialty drug pharmacy services, cost containment, clinical, safety and adherence programs for
565	565	536pharmacy services and managing the cost of covered prescription drugs; provided further, that
566	566	537“pharmacy benefit manager” shall not include a health benefit plan unless otherwise specified by
567	567	538the division.
568	568	539 Section 2. (a) A person, business or other entity shall not establish or operate as a
569	569	540pharmacy benefit manager in the commonwealth without obtaining a license from the division
570	570	541pursuant to this section. The division shall issue a pharmacy benefit manager license to a person,
571	571	542business or other entity that demonstrates to the division that it has the necessary organization,
572	572	543background expertise and financial integrity to maintain such a license. A pharmacy benefit
573	573	544manager license shall be valid for a period of 3 years and shall be renewable for additional 3-
574	574	545year periods. Initial application and renewal fees for the license shall be established pursuant to
575	575	546section 3B of chapter 7. 27 of 29
576	576	547 (b) A license granted pursuant to this section and any rights or interests therein shall not
577	577	548be transferable.
578	578	549 (c) A person, business or other entity licensed as a pharmacy benefit manager shall
579	579	550submit data and reporting information to the center according to the standards and methods
580	580	551specified by the center pursuant to section 10A of chapter 12C.
581	581	552 (d) The division may issue or renew a license subject to restrictions in order to protect the
582	582	553interests of consumers. Such restrictions may include limiting the type of services that a license
583	583	554holder may provide, limiting the activities in which the license holder may be engaged or
584	584	555addressing conflicts of interest between pharmacy benefit managers and health plan sponsors.
585	585	556 (e) The division shall develop an application for licensure that shall include, but not be
586	586	557limited to: (1) the name of the pharmacy benefit manager; (2) the address and contact telephone
587	587	558number for the pharmacy benefit manager; (3) the name and address of the pharmacy benefit
588	588	559manager’s agent for service of process in the commonwealth; (4) the name and address of each
589	589	560person with management or control over the pharmacy benefit manager; and (5) any audited
590	590	561financial statements specific to the pharmacy benefit manager. A pharmacy benefit manager
591	591	562shall report to the division any material change to the information contained in its application,
592	592	563certified by an officer of the pharmacy benefit manager, within 30 days of such a change.
593	593	564 (f) The division may suspend, revoke, refuse to issue or renew or place on probation a
594	594	565pharmacy benefit manager license for cause, which shall include, but not be limited to: (1) the
595	595	566pharmacy benefit manager engaging in fraudulent activity that constitutes a violation of state or
596	596	567federal law; (2) the division receiving consumer complaints that justify an action under this
597	597	568chapter to protect the health, safety and interests of consumers; (3) the pharmacy benefit 28 of 29
598	598	569manager failing to pay an application or renewal fee for a license; (4) the pharmacy benefit
599	599	570manager failing to comply with reporting requirements of the center under section 10A of
600	600	571chapter 12C; or (5) the pharmacy benefit manager failing to comply with a requirement of this
601	601	572chapter.
602	602	573 The division shall provide written notice to the pharmacy benefit manager and advise in
603	603	574writing of the reason for any suspension, revocation, refusal to issue or renew or placement on
604	604	575probation of a pharmacy benefit manager license under this chapter. A copy of the notice shall be
605	605	576forwarded to the center. The applicant or pharmacy benefit manager may make written demand
606	606	577upon the division within 30 days of receipt of such notification for a hearing before the division
607	607	578to determine the reasonableness of the division’s action. The hearing shall be held pursuant to
608	608	579chapter 30A.
609	609	580 The division shall not suspend or cancel a license unless the division has first afforded
610	610	581the pharmacy benefit manager an opportunity for a hearing pursuant to said chapter 30A.
611	611	582 (g) If a person, business or other entity performs the functions of a pharmacy benefit
612	612	583manager in violation of this chapter, the person, business or other entity shall be subject to a fine
613	613	584of $5,000 per day for each day that the person, business or other entity is found to be in violation.
614	614	585 (h) A pharmacy benefit manager shall be required to submit to periodic audits by a carrier
615	615	586licensed under chapters 175, 176A, 176B or 176G if the pharmacy benefit manager has entered
616	616	587into a contract with the carrier to provide pharmacy benefit services to the carrier or its members.
617	617	588The division may direct or provide specifications for such audits.
618	618	589 (i) A pharmacy benefit manager licensed under this section shall notify a health carrier
619	619	590client in writing of any activity, policy, practice contract or arrangement of the pharmacy benefit 29 of 29
620	620	591manager that directly or indirectly presents any conflict of interest with the pharmacy benefit
621	621	592manager’s relationship with or obligation to the health carrier client.