Massachusetts 2025-2026 Regular Session

Massachusetts House Bill H1364 Compare Versions

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

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1	1	1 of 1
2	2	HOUSE DOCKET, NO. 3091 FILED ON: 1/16/2025
3	3	HOUSE . . . . . . . . . . . . . . . No. 1364
4	4	The Commonwealth of Massachusetts
5	5	_________________
6	6	PRESENTED BY:
7	7	Carole A. Fiola
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 relative to promoting healthcare access and affordability for patients.
13	13	_______________
14	14	PETITION OF:
15	15	NAME:DISTRICT/ADDRESS :DATE ADDED:Carole A. Fiola6th Bristol1/16/2025 1 of 5
16	16	HOUSE DOCKET, NO. 3091 FILED ON: 1/16/2025
17	17	HOUSE . . . . . . . . . . . . . . . No. 1364
18	18	By Representative Fiola of Fall River, a petition (accompanied by bill, House, No. 1364) of
19	19	Carole A. Fiola relative to healthcare access and affordability for patients. Health Care
20	20	Financing.
21	21	The Commonwealth of Massachusetts
22	22	_______________
23	23	In the One Hundred and Ninety-Fourth General Court
24	24	(2025-2026)
25	25	_______________
26	26	An Act relative to promoting healthcare access and affordability for patients.
27	27	Be it enacted by the Senate and House of Representatives in General Court assembled, and by the authority
28	28	of the same, as follows:
29	29	1 SECTION 1. Sections 131 and 226 of chapter 139 of the acts of 2012 are hereby
30	30	2repealed.
31	31	3 SECTION 2:  Chapter 176O of the General Laws is hereby amended by adding the
32	32	4following section:-
33	33	5 Section 31. (a) As used in this section, the following words shall, unless the context
34	34	6clearly requires otherwise, have the following meanings:
35	35	7 “Cost-sharing”, as defined in subsection (a) of section 21C of chapter 94C.
36	36	8 “Estimated rebate”, any: (i) negotiated price concessions, whether described as a rebate
37	37	9or otherwise, including, but not limited to, base price concessions, and reasonable estimates of
38	38	10any price protection rebates and performance-based price concessions that may accrue, directly
39	39	11or indirectly, to a carrier, pharmacy benefit manager or other party on a carrier’s behalf during a 2 of 5
40	40	12carrier’s plan year from a pharmaceutical manufacturing company, dispensing pharmacy or other
41	41	13party to the transaction based on the amounts the carrier received in the prior quarter or
42	42	14reasonably expects to receive in the current quarter; and (ii) reasonable estimates of any price
43	43	15concessions, fees and other administrative costs that are passed through, or are reasonably
44	44	16anticipated to be passed through to the carrier, pharmacy benefit manager or other party on the
45	45	17carrier’s behalf and that serve to reduce the carrier’s prescription drug liabilities for the plan year
46	46	18based on the amounts the carrier received in the prior quarter or reasonably expects to receive in
47	47	19the current quarter.
48	48	20 “Pharmacy benefit manager”, as defined in section 1 of chapter 176Y.
49	49	21 “Price protection rebate”, a negotiated price concession that accrues directly or indirectly
50	50	22to the carrier, or other party on behalf of the carrier, including a pharmacy benefit manager, in
51	51	23the event of an increase in the wholesale acquisition cost of a drug that is greater than a specified
52	52	24threshold.
53	53	25 (b) A carrier, or any pharmacy benefit manager, shall make available to an insured at
54	54	26least 80 per cent of the estimated rebates received by such carrier, or any pharmacy benefit
55	55	27manager, by reducing the amount of defined cost-sharing that the carrier would otherwise charge
56	56	28at the point of sale, except that the reduction amount shall not result in a credit at the point of
57	57	29sale. Neither the insured nor the carrier shall be responsible for any difference between the
58	58	30estimated rebate amount and the actual rebate amount the carrier receives; provided, that such
59	59	31estimates were calculated in good faith.
60	60	32 (c) Nothing in this section shall preclude a pharmacy benefit manager from decreasing an
61	61	33insured’s defined cost-sharing by an amount greater than that required under subsection (b). 3 of 5
62	62	34 (d) Annually, not later than April 1, a carrier shall file with the division a report in the
63	63	35manner and form determined by the commissioner demonstrating the manner in which the carrier
64	64	36has complied with this section. If the commissioner determines that a carrier has not complied
65	65	37with 1 or more requirements of this section, the commissioner shall notify the carrier of such
66	66	38noncompliance and a date by which the carrier must demonstrate compliance. If the carrier does
67	67	39not come into compliance by such date, the division shall impose a fine not to exceed $5,000 for
68	68	40each day during which such noncompliance continues.
69	69	41 (e) In implementing the requirements of this section, the division shall only regulate a
70	70	42carrier or pharmacy benefit manager to the extent permissible under applicable law.
71	71	43 (f) A pharmacy benefit manager, its agent or any third-party administrator shall not
72	72	44publish or otherwise disclose information regarding the actual amount of rebates a carrier
73	73	45receives on a specific product or therapeutic class of products, manufacturer or pharmacy-
74	74	46specific basis. Such information shall be considered to be a trade secret and confidential
75	75	47commercial information, shall not be a public record as defined by clause Twenty-sixth of
76	76	48section 7 of chapter 4 or section 10 of chapter 66, and shall not be disclosed directly or
77	77	49indirectly, or in a manner that would allow for the identification of an individual product,
78	78	50therapeutic class of products or manufacturer, or in a manner that would have the potential to
79	79	51compromise the financial, competitive or proprietary nature of the information. A pharmacy
80	80	52benefit manager shall impose the confidentiality protections and requirements of this section on
81	81	53any agent or third-party administrator that performs health care or administrative services on
82	82	54behalf of the pharmacy benefit manager that may receive or have access to rebate related
83	83	55information. 4 of 5
84	84	56 SECTION 3. (a) Notwithstanding any general or special law to the contrary, the health
85	85	57policy commission, together with the secretary of the executive office of health and human
86	86	58services, shall conduct an analysis and issue a report on the future of cell and gene therapy in the
87	87	59commonwealth with the objective of addressing anticipated barriers to access that may exist with
88	88	60respect to such treatments for patients covered by MassHealth programs and other vulnerable
89	89	61populations.  The analysis and report shall include, but not be limited to:
90	90	62 (1) a projection of the estimated total number of cell and gene therapy products, including
91	91	63information on the diseases and conditions such products will be approved to treat (including the
92	92	64total estimated number of lives impacted in the commonwealth, and the total number receiving
93	93	65care under MassHealth), that are expected to come to market in the U.S. (hereinafter the
94	94	66“products”) during a forecast period of 2027 to 2037 (hereinafter, the “forecast period”);
95	95	67 (2) an assessment of existing reimbursement frameworks and methodologies employed
96	96	68by MassHealth for the products to the extent purchased by health care facilities for
97	97	69administration to MassHealth beneficiaries during inpatient hospital stays;
98	98	70 (3) an assessment of whether the reimbursement frameworks and methodologies
99	99	71identified in subdivision (2) would lead to barriers to access to the products during the forecast
100	100	72period in light of the projected costs to the Massachusetts health care system associated with the
101	101	73utilization of the products, and whether such barriers to access, if any, would disproportionately
102	102	74impact MassHealth beneficiaries or other vulnerable populations, including population groups
103	103	75that may be more likely to have adverse health outcomes due to experience with historic
104	104	76disparities or discrimination, including racial or ethnic minority population groups; 5 of 5
105	105	77 (4) An assessment of whether the health care facility infrastructure in place and planned
106	106	78for development during the forecast period, and that is necessary of the administration of the
107	107	79products, will be adequate to ensure equitable access for patients in need of treatment with the
108	108	80products.
109	109	81 (b) To the extent that the analysis required under subdivision (3) of subsection (a)
110	110	82identifies any barriers to access, the commission and the secretary shall analyze and report on the
111	111	83reasons for such barriers and shall propose corrective policy solutions.  If any identified barriers
112	112	84are the result of or otherwise related to current MassHealth reimbursement methodologies for
113	113	85gene and cell therapies, the commission and the secretary shall propose modifications to such
114	114	86methodologies to the extent authorized under Federal law.  Such proposed modifications shall
115	115	87address and be designed to eliminate any disproportionate impact of the access barriers on
116	116	88MassHealth beneficiaries or other vulnerable populations.
117	117	89 (c)  In conducting the analysis and producing the report as required by subsection (a), the
118	118	90secretary and the commission shall consult with the Massachusetts Biotechnology Council or a
119	119	91designee, the Massachusetts Hospital Association or a designee, the Conference of Boston
120	120	92Teaching Hospitals or a designee, and the rare disease advisory council established pursuant to
121	121	93section 26 of chapter 260 of the acts of 2020.
122	122	94 (d)  The report shall be made available electronically on the commission’s website, and
123	123	95shall be filed with the secretary of administration and finance, the clerks of the house of
124	124	96representatives and the senate, the house and senate committees on ways and means and the joint
125	125	97committee on health care financing no later than July 30, 2028.