Bill S.868 194th (Current)

The bill improves health care affordability for residents of the Commonwealth by directing the Health Policy Commission (HPC) and the Center for Health Information and Analysis (CHIA) to set affordability goals for the state and establish an affordability benchmark. The bill would direct HPC to determine whether a material change for a health care entity is likely to result in a significant negative impact on health care consumers and would authorize HPC to recommend modifications to mitigate such impacts.

To improve affordability of prescription drugs, the bill would direct the HPC, in consultation with stakeholders, to establish a process for identifying high-cost drugs and essential public health drugs with large price increases, determining proposed values of such drugs, and establishing an upper payment limit for drugs with prices that substantially exceed HPC’s proposed value. Other provisions related to prescription drugs include expanding cost-sharing limits to the three most prevalent heart conditions and include continuous glucose monitoring systems and drug delivery devices and prohibiting PBMs from engaging in practices that would unfairly reduce payments to pharmacies and increase costs for patients. 

The bill seeks to protect the financial stability of the Commonwealth’s health care system by prohibiting private equity companies and real estate investment trusts (REITs) from engaging in transactions that would likely cause financial distress to providers or provider organizations that the private equity company or REIT owns or controls. Private equity companies would be required to deposit a bond with DPH upon submission of a material change notice to the HPC. The bill would also prohibit management services organizations and health care entities from interfering with or controlling the clinical decisions of health care practitioners.