Amendment ID: S2397-40

Amendment 40

Cost Growth Benchmark Factor

Ms. Lovely moves that the proposed new draft be amended in section 19, in line 214, by inserting after the word “access” the following:- “and on the commonwealth’s ability to meet the health care cost growth benchmark as defined in said Section 1 of Chapter 6D;”

And in line 244 by inserting after the word “access” the following:- “and the commonwealth’s ability to meet the health care cost growth benchmark as defined in said Section 1 of Chapter 6D;”

And further amend said section 19 by striking paragraph (d) in line 240 and inserting in place thereof the following:-

(d) If, after review of an eligible drug and after receiving information from the manufacturer under subsections (b) or (e), the commission determines that the manufacturer’s pricing of the eligible drug does not substantially exceed the proposed value of the drug, the commission shall notify the manufacturer, in writing, of its determination and shall evaluate other ways to mitigate the eligible drug’s cost in order to improve patient access to the eligible drug. The commission may engage with the manufacturer and other relevant stakeholders, including, but not limited to, patients, patient advocacy organizations, providers, provider organizations and payers, to explore options for mitigating the cost of the eligible drug. Upon the conclusion of a stakeholder engagement process under this subsection, the commission shall issue recommendations on ways to reduce the cost of the eligible drug for the purpose of improving patient access and furthering the commonwealth’s ability to meet the health care cost growth benchmark as defined in said Section 1 of Chapter 6D to the eligible drug. Recommendations may include, but not be limited to: (i) an alternative payment plan or methodology; (ii) a bulk purchasing program; (iii) co-pay, deductible, coinsurance or other cost-sharing restrictions; and (iv) a reinsurance program to subsidize the cost of the eligible drug, and (v) any other recommendations the commission develops that are intended to address the impact on the state’s cost growth benchmark as defined in said section 1 of chapter 6D. The recommendations shall be publicly posted on the commission’s website and provided to the clerks of the house of representatives and senate, the joint committee on health care financing and the house and senate committees on ways and means.

And in line 300 by inserting after the word “access” the following:- “and the commonwealth’s ability to meet the health care cost growth benchmark as defined in said Section 1 of Chapter 6D;”

And in line 306 by inserting after the word “access” the following:- “and the commonwealth’s ability to meet the health care cost growth benchmark as defined in said Section 1 of Chapter 6D;”

And in line 348 by inserting after the word “access” the following:- “and the commonwealth’s ability to meet the health care cost growth benchmark as defined in said Section 1 of Chapter 6D;”