SECTION 1. Chapter 118G of the of the General Laws, as appearing in the 2010 official edition, is hereby amended by inserting after section 41 the following section:-

Section 42. (a) For the purposes of this section, the following words shall have the following meanings:-

“PBM   Pharmacy benefit manager,” an entity that processes prescription claims for pharmacies in real time and pays the retail pharmacy  a  PBM  may also process and fill mail order prescriptions to send directly to patients.  The PBM is a go-between from the patients insurance company and the pharmacy the patient has chosen to fill their medication prescription.

“Co-pay,” the amount paid by a patient or the patients representative for any particular prescription either at retail or by mail order.

“Specialty drug,” a medication that requires special dispensing pharmacies to dispense as determined by the drug manufacturer or a medication determined by a PBM to require a specialty pharmacy to dispense.

“Prior Approval,” a process in which the PBM is contacted by the patients prescriber of medication to get an approval in order for the medication to be paid for by the PBM.

(b) All persons residing in Massachusetts (including those insured under the State GIC) may choose to have their prescription for medication filled at the pharmacy of their choice within Massachusetts.  The patient may choose to utilize the PBM or the local pharmacy at the same terms and Co-pay.

(c) The Massachusetts Board of Registration in Pharmacy shall be directed to register any PBM or other mail pharmacy or pharmacies under Massachusetts laws and regulations which ships 5% or more of its medication orders either via the mail or other common carriers into Massachusetts. 

(d) When the outside temperatures in Massachusetts are predicted to range outside of the range as specified by a particular medications’ manufacturer for 48 hours or more the PBM must contact the patient and request the name and number of a local pharmacy in which the patient may obtain enough of their medication locally to cover for the time period involved until the shipping of the patients medication can resume. The PBM will contact the local pharmacy and arrange for the emergency supply to be dispensed at the expense of the PBM. The Co-pay to be charged if any shall be pro-rated for the amount of medication that will be dispensed based on the patients’ original Co-pay for the prescription that would have been sent as mentioned above in this section.

(e) Medications requiring Prior Approval shall be given at least a one-time override at the request of the Retail pharmacy in order for continuity of care to be provided to the patient. The PBM will then contact the prescriber of the medication to arrange for either continued dispensing of the same medication or a change to the preferred medication of the PBM.   Federal regulations for Medicare D prescriptions shall not be affected by this provision and the Medicare D “Transitional Supply”.

(f) Prescriptions for Specialty Drugs may not be blocked from being filled at the pharmacy of the patients’ choice unless required to be done so by the particular Specialty drug’s manufacturer.