SECTION 1. Chapter 6D of the General Laws is hereby amended by inserting after section 18 the following new section:-
Section 19. (a)(1) The commission, in consultation with the center, shall create annually a list of 10 drugs on which the commonwealth’s MassHealth program spends significant health care dollars and for which the wholesale acquisition cost has increased by 50 percent or more over the past five years or by 15 percent or more during the previous calendar year, or both. The list shall include at least one generic and one brand name drug and shall indicate each of the drugs on the list that the commission considers specialty tier drugs.
(2) Each carrier with more than 5,000 covered lives in the commonwealth for major medical health insurance shall create annually a list of 10 prescription drugs on which its health insurance plans spend significant amounts of their premium dollars and for which the cost to the plans, net of rebates and other price concessions, has increased by 50 percent or more over the past five years or by 15 percent or more during the previous calendar year, or both. The list shall include at least one generic and one brand name drug and shall indicate each of the drugs on the list that the insurer considers specialty tier drugs.
(3) The commission and payers shall provide to the office of the attorney general the lists of prescription drugs developed pursuant to this section annually on or before June 1. Each carrier shall provide the office of the attorney general the percentage by which the net cost to its plans increased over the applicable period or periods for each drug on the list, as well as the carrier’s total expenditure, net of rebates and other price concessions, for each drug on the list during the most recent calendar year.
(b) Of the prescription drugs listed by the commission and the carriers pursuant to subsection (a) of this section, the office of the attorney general shall identify up to 15 drugs, of those appearing on more than one payer’s list, on which the greatest amount of money was spent across all payers during the previous calendar year.
(1)For the 15 drugs identified by the office of the attorney general pursuant to subsection (b) of this section, the office of the attorney general shall require the manufacturer of each such drug to provide all relevant information and supporting documentation necessary to justify the increase in the net cost of the drug.
(2)The attorney general shall provide a report to the legislature on or before December 1 of each year based on the information received from manufacturers pursuant to this section.
(c) The commission shall promulgate all regulations necessary to implement this section, including, but not limited to, establishing penalties for noncompliance with the requirements set forth in this section.
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