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SENATE DOCKET, NO. 1797 FILED ON: 1/16/2025
SENATE . . . . . . . . . . . . . . No. 724
The Commonwealth of Massachusetts
_________________
PRESENTED BY:
Sal N. DiDomenico
_________________
To the Honorable Senate and House of Representatives of the Commonwealth of Massachusetts in General
Court assembled:
The undersigned legislators and/or citizens respectfully petition for the adoption of the accompanying bill:
An Act promoting healthcare access and affordability for patients.
_______________
PETITION OF:
NAME:DISTRICT/ADDRESS :Sal N. DiDomenicoMiddlesex and Suffolk 1 of 5
SENATE DOCKET, NO. 1797 FILED ON: 1/16/2025
SENATE . . . . . . . . . . . . . . No. 724
By Mr. DiDomenico, a petition (accompanied by bill, Senate, No. 724) of Sal N. DiDomenico
for legislation to promote healthcare access and affordability for patients. Financial Services.
The Commonwealth of Massachusetts
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In the One Hundred and Ninety-Fourth General Court
(2025-2026)
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An Act promoting healthcare access and affordability for patients.
Be it enacted by the Senate and House of Representatives in General Court assembled, and by the authority
of the same, as follows:
1 SECTION 1. Sections 131 and 226 of chapter 139 of the acts of 2012 are hereby
2repealed.
3 SECTION 2. Chapter 176O of the General Laws is hereby amended by adding the
4following section:-
5 Section 31. (a) As used in this section, the following words shall, unless the context
6clearly requires otherwise, have the following meanings:
7 “Cost-sharing”, as defined in subsection (a) of section 21C of chapter 94C.
8 “Estimated rebate”, any: (i) negotiated price concessions, whether described as a rebate
9or otherwise, including, but not limited to, base price concessions, and reasonable estimates of
10any price protection rebates and performance-based price concessions that may accrue, directly
11or indirectly, to a carrier, pharmacy benefit manager or other party on a carrier’s behalf during a
12carrier’s plan year from a pharmaceutical manufacturing company, dispensing pharmacy or other 2 of 5
13party to the transaction based on the amounts the carrier received in the prior quarter or
14reasonably expects to receive in the current quarter; and (ii) reasonable estimates of any price
15concessions, fees and other administrative costs that are passed through, or are reasonably
16anticipated to be passed through to the carrier, pharmacy benefit manager or other party on the
17carrier’s behalf and that serve to reduce the carrier’s prescription drug liabilities for the plan year
18based on the amounts the carrier received in the prior quarter or reasonably expects to receive in
19the current quarter.
20 “Pharmacy benefit manager”, as defined in section 1 of chapter 176Y.
21 “Price protection rebate”, a negotiated price concession that accrues directly or indirectly
22to the carrier, or other party on behalf of the carrier, including a pharmacy benefit manager, in
23the event of an increase in the wholesale acquisition cost of a drug that is greater than a specified
24threshold.
25 (b) A carrier, or any pharmacy benefit manager, shall make available to an insured at
26least 80 per cent of the estimated rebates received by such carrier, or any pharmacy benefit
27manager, by reducing the amount of defined cost-sharing that the carrier would otherwise charge
28at the point of sale, except that the reduction amount shall not result in a credit at the point of
29sale. Neither the insured nor the carrier shall be responsible for any difference between the
30estimated rebate amount and the actual rebate amount the carrier receives; provided, that such
31estimates were calculated in good faith.
32 (c) Nothing in this section shall preclude a pharmacy benefit manager from decreasing an
33insured’s defined cost-sharing by an amount greater than that required under subsection (b). 3 of 5
34 (d) Annually, not later than April 1, a carrier shall file with the division a report in the
35manner and form determined by the commissioner demonstrating the manner in which the carrier
36has complied with this section. If the commissioner determines that a carrier has not complied
37with 1 or more requirements of this section, the commissioner shall notify the carrier of such
38noncompliance and a date by which the carrier must demonstrate compliance. If the carrier does
39not come into compliance by such date, the division shall impose a fine not to exceed $5,000 for
40each day during which such noncompliance continues.
41 (e) In implementing the requirements of this section, the division shall only regulate a
42carrier or pharmacy benefit manager to the extent permissible under applicable law.
43 (f) A pharmacy benefit manager, its agent or any third-party administrator shall not
44publish or otherwise disclose information regarding the actual amount of rebates a carrier
45receives on a specific product or therapeutic class of products, manufacturer or pharmacy-
46specific basis. Such information shall be considered to be a trade secret and confidential
47commercial information, shall not be a public record as defined by clause Twenty-sixth of
48section 7 of chapter 4 or section 10 of chapter 66, and shall not be disclosed directly or
49indirectly, or in a manner that would allow for the identification of an individual product,
50therapeutic class of products or manufacturer, or in a manner that would have the potential to
51compromise the financial, competitive or proprietary nature of the information. A pharmacy
52benefit manager shall impose the confidentiality protections and requirements of this section on
53any agent or third-party administrator that performs health care or administrative services on
54behalf of the pharmacy benefit manager that may receive or have access to rebate related
55information. 4 of 5
56 SECTION 3. (a) Notwithstanding any general or special law to the contrary, the health
57policy commission, together with the secretary of the executive office of health and human
58services, shall conduct an analysis and issue a report on the future of cell and gene therapy in the
59commonwealth with the objective of addressing anticipated barriers to access that may exist with
60respect to such treatments for patients covered by MassHealth programs and other vulnerable
61populations. The analysis and report shall include, but not be limited to:
62 (1) a projection of the estimated total number of cell and gene therapy products, including
63information on the diseases and conditions such products will be approved to treat (including the
64total estimated number of lives impacted in the commonwealth, and the total number receiving
65care under MassHealth), that are expected to come to market in the U.S. (hereinafter the
66“products”) during a forecast period of 2027 to 2037 (hereinafter, the “forecast period”);
67 (2) an assessment of existing reimbursement frameworks and methodologies employed
68by MassHealth for the products to the extent purchased by health care facilities for
69administration to MassHealth beneficiaries during inpatient hospital stays;
70 (3) an assessment of whether the reimbursement frameworks and methodologies
71identified in subdivision (2) would lead to barriers to access to the products during the forecast
72period in light of the projected costs to the Massachusetts health care system associated with the
73utilization of the products, and whether such barriers to access, if any, would disproportionately
74impact MassHealth beneficiaries or other vulnerable populations, including population groups
75that may be more likely to have adverse health outcomes due to experience with historic
76disparities or discrimination, including racial or ethnic minority population groups; 5 of 5
77 (4) An assessment of whether the health care facility infrastructure in place and planned
78for development during the forecast period, and that is necessary of the administration of the
79products, will be adequate to ensure equitable access for patients in need of treatment with the
80products.
81 (b) To the extent that the analysis required under subdivision (3) of subsection (a)
82identifies any barriers to access, the commission and the secretary shall analyze and report on the
83reasons for such barriers and shall propose corrective policy solutions. If any identified barriers
84are the result of or otherwise related to current MassHealth reimbursement methodologies for
85gene and cell therapies, the commission and the secretary shall propose modifications to such
86methodologies to the extent authorized under Federal law. Such proposed modifications shall
87address and be designed to eliminate any disproportionate impact of the access barriers on
88MassHealth beneficiaries or other vulnerable populations.
89 (c) In conducting the analysis and producing the report as required by subsection (a), the
90secretary and the commission shall consult with the Massachusetts Biotechnology Council or a
91designee, the Massachusetts Hospital Association or a designee, the Conference of Boston
92Teaching Hospitals or a designee, and the rare disease advisory council established pursuant to
93section 26 of chapter 260 of the acts of 2020.
94 (d) The report shall be made available electronically on the commission’s website, and
95shall be filed with the secretary of administration and finance, the clerks of the house of
96representatives and the senate, the house and senate committees on ways and means and the joint
97committee on health care financing no later than July 30, 2028.