An Act to ensure access to prescription medication and community pharmacies
By Mr. Tarr, a petition (accompanied by bill, Senate, No. 831) of Bruce E. Tarr for legislation to ensure access to prescription medication and community pharmacies. Financial Services.
Bill Information
Bill Information
- Presenter:
- Bruce E. Tarr
- Status:
- Referred to Joint Committee on Health Care Financing
moves to regulate Pharmacy Benefit Managers (PBMs) to protect community pharmacies and ensure patient access to medications. Requires fair pharmacy reimbursement, with dispensing fees no less than State Medicaid Program rates and equal or greater payment for non-PBM affiliated pharmacies. The bill prohibits retroactive payment reductions and "pharmacy steering"—directing patients to PBM-owned pharmacies. It mandates that any licensed Massachusetts pharmacy willing to meet service requirements must be allowed to dispense all medications, including specialty drugs, and that these requirements cannot be designed to exclude community pharmacies. prohibits PBMs from requiring or incentivizing brand-name drug use when a generic is available (except for Medicaid), establishes rules for pharmacy audits that allow post-audit validation and limit recoupment for minor clerical errors to the dispensing fee (with audit revenue going to the plan sponsor), and bans PBMs from charging community pharmacies credentialing fees. The Insurance Commissioner is tasked with enforcement, including audits, and PBMs must report annually on denied appeals
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