Budget Amendment ID: FY2018-S3-465

EHS 465

Consumer Protection for Purchasing Prescription Drugs

Messrs. Welch, Lewis, Montigny and O'Connor moved that the proposed new text be amended by inserting after section 60 the following new section:- “Section XX:  Chapter 175 of the General Laws is hereby amended by adding after Section 26, the following new section: -

Section 26A.

For the purpose of this section, the following terms shall have the following meanings:

“Registered Pharmacist”, a pharmacist who, pursuant to the provisions of M.G.L. c. 112, § 24, is registered by the Board to practice pharmacy.

“Cost-sharing”, the costs covered by a consumer’s insurance that the consumer pays out of their own pocket.

“Usual and customary charge”, the lowest price that a provider charges or accepts from any payer for the same quantity of a drug on the same date of service, in Massachusetts, including but not limited to the shelf price, sale price, or advertised price for any drug including an over-the-counter drug. If an insurer and the provider have a contract that specifies that the insurer will pay an average or similarly computed fixed amount for multiple therapeutic categories of drugs with different acquisition costs, the fixed amount will not be the provider’s usual and customary charge.

(a) A pharmacy shall post a notice to consumers informing them that they may obtain current usual and customary price information for medications from the pharmacist.  If a pharmacist, or person acting at the direction of a pharmacist, determines that the cost-sharing requirement imposed by an insurer or pharmacy benefits manager for a medication exceeds the current usual and customary price for cash customers, they shall notify the customer of the expected out-of-pocket cost differences between available payment options.

(b) A pharmacist shall charge a customer the cost-sharing amount required under their insurance plan or the pharmacy’s usual and customary price for cash customers for a medication, whichever is less.

(c) No pharmacist shall be penalized by the board or any third party for failure to comply with the provisions of this Section.