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| 2 | 2 | | HOUSE DOCKET, NO. 3872 FILED ON: 1/17/2025 |
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| 3 | 3 | | HOUSE . . . . . . . . . . . . . . . No. 1305 |
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| 4 | 4 | | The Commonwealth of Massachusetts |
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| 5 | 5 | | _________________ |
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| 6 | 6 | | PRESENTED BY: |
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| 7 | 7 | | Daniel J. Ryan |
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| 8 | 8 | | _________________ |
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| 9 | 9 | | To the Honorable Senate and House of Representatives of the Commonwealth of Massachusetts in General |
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| 10 | 10 | | Court assembled: |
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| 11 | 11 | | The undersigned legislators and/or citizens respectfully petition for the adoption of the accompanying bill: |
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| 12 | 12 | | An Act to help patients and reduce health care costs by ensuring patient adherence to |
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| 13 | 13 | | medications. |
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| 14 | 14 | | _______________ |
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| 15 | 15 | | PETITION OF: |
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| 16 | 16 | | NAME:DISTRICT/ADDRESS :DATE ADDED:Daniel J. Ryan2nd Suffolk1/17/2025 1 of 2 |
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| 17 | 17 | | HOUSE DOCKET, NO. 3872 FILED ON: 1/17/2025 |
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| 18 | 18 | | HOUSE . . . . . . . . . . . . . . . No. 1305 |
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| 19 | 19 | | By Representative Ryan of Boston, a petition (accompanied by bill, House, No. 1305) of Daniel |
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| 20 | 20 | | J. Ryan relative to further regulating individual or group health insurance policies providing |
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| 21 | 21 | | prescription drug coverage. Financial Services. |
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| 22 | 22 | | [SIMILAR MATTER FILED IN PREVIOUS SESSION |
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| 23 | 23 | | SEE HOUSE, NO. 1135 OF 2023-2024.] |
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| 24 | 24 | | The Commonwealth of Massachusetts |
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| 25 | 25 | | _______________ |
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| 26 | 26 | | In the One Hundred and Ninety-Fourth General Court |
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| 27 | 27 | | (2025-2026) |
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| 28 | 28 | | _______________ |
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| 29 | 29 | | An Act to help patients and reduce health care costs by ensuring patient adherence to |
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| 30 | 30 | | medications. |
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| 31 | 31 | | Be it enacted by the Senate and House of Representatives in General Court assembled, and by the authority |
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| 32 | 32 | | of the same, as follows: |
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| 33 | 33 | | 1 SECTION 1. An individual or group health insurance policy providing prescription drug |
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| 34 | 34 | | 2coverage in the state must permit and apply a pro-rated daily cost-sharing rate to prescriptions |
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| 35 | 35 | | 3that are dispensed by a network pharmacy for a partial supply if the prescriber or pharmacist |
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| 36 | 36 | | 4determines the fill or refill to be in the best interest of the patient and the patient requests or |
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| 37 | 37 | | 5agrees to a partial supply for the purpose of synchronizing the patient’s medications. |
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| 38 | 38 | | 6 No individual or group health insurance policy providing prescription drug coverage shall |
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| 39 | 39 | | 7deny coverage for the dispensing of a medication that is dispensed by a network pharmacy on the |
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| 40 | 40 | | 8basis that the dispensing is for a partial supply if the prescriber or pharmacist determines the fill |
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| 41 | 41 | | 9or refill to be in the best interest of the patient and the patient requests or agrees to a partial 2 of 2 |
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| 42 | 42 | | 10supply for the purpose of synchronizing the patient’s medications. The individual or group health |
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| 43 | 43 | | 11plan must allow a pharmacy to override any denial codes indicating that a prescription is being |
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| 44 | 44 | | 12refilled too soon for the purposes of medication synchronization. |
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| 45 | 45 | | 13 No individual or group health insurance policy providing prescription drug coverage shall |
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| 46 | 46 | | 14use payment structures incorporating pro-rated dispensing fees. Dispensing fees for partially |
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| 47 | 47 | | 15filled or refilled prescriptions shall be paid in full for each prescription dispensed, regardless of |
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| 48 | 48 | | 16any pro-rated copay for the beneficiary or fee paid for alignment services. |
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