Consolidated Amendment "A" to H4891
Consolidated Amendment
Consolidated Amendment A
Amendments: 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 29, 31, 33, 34, 35, 36, 37, 38, 39, 40, 41, 42, 43
Mr. Michlewitz of Boston and others move to amend the H.4891 in section 2 by inserting after the word “include”, in line 14, the following words:- a hospital licensed under section 51 of chapter 111,.
And further amend the bill in section 16 by inserting after the word “include”, in line 228, the following words:- a hospital licensed under section 51 of chapter 111,.
And further amend the bill by inserting after section 28 the following 2 sections:-
SECTION 28A. Chapter 111 of the General Laws is hereby amended by adding the following section:-
Section 245. (a) The department shall implement a provider immunization brand choice requirement as part of the commonwealth’s universal immunization program under section 24I, routine childhood immunizations under 24N; the Vaccines for Children Program operated by the department under the authority of 42 U.S.C. §1396s; and in any other existing or future immunization program for children or adults administered by the commonwealth using local, state or federal funds.
(b) For all categories of immunizations included in subsection (a), all participating health care providers shall be able to select any brand or type of immunization, including any combination immunization and dosage form, as long as the immunization is licensed or authorized for emergency use by the federal Food and Drug Administration and recommended by the federal Centers for Disease Control and Prevention Advisory Committee on Immunization Practices. The department shall not limit the ability of such health care providers to provide an immunization by limiting the supply of immunizations purchased by the department. This section shall not apply in the event of a shortage or delay in vaccine availability, disaster or public health emergency, terrorist attack, hostile military or paramilitary action, or extraordinary law enforcement emergency.
(c) The department shall, for the purposes of the purchase, delivery and administration of vaccines, use the Center for Disease Control and Prevention vaccine list established, and periodically reviewed and revised, by the federal Centers for Disease Control and Prevention Advisory Committee on Immunization Practices.
(d) The department shall implement all or part of the provider immunization brand choice requirement as soon as practicable; provided, however, that the department shall complete full implementation of the system not later than July 1, 2025.
SECTION 28B. Chapter 112 of the General Laws is hereby amended by inserting after section 38 the following section:-
Section 38A. (a) For the purposes of this section, a “pharmacy desert” shall mean an area where there is no or limited access to pharmacies due to factors, but not limited to: (i) geographic location, specifically areas where the nearest pharmacy is more than 1 mile away in urban areas, more than 5 miles away in suburban areas, and more than 10 miles away in rural areas; (ii) distance and travel time, defined as travel time exceeding 15 minutes by car or 30 minutes by public transportation; (iii) limited access to transportation, both public and private, including areas with infrequent public transit services or where at least 20 per cent of the population lacks access to private vehicles.
(b) Any entity that intends to close a pharmacy or pharmacy department registered by the board for the transaction of a “drug business”, as defined in section 37, shall notify the board in writing at least 60 days before the proposed closure date. The entity shall send a copy of the notice to the members of the General Court who represent the municipality in which the pharmacy or pharmacy department is located, and the clerk of the municipality in which the pharmacy or pharmacy department is located, who shall distribute the notice to the appropriate local officials. Within 15 days of receipt of the notice of the intended closing, the board shall conduct a review to determine whether the intended closing is likely to result in the creation of a pharmacy desert. If the board finds that the intended closing is likely to result in the creation of a pharmacy desert, the board shall conduct a public hearing not later than 45 calendar days prior to the proposed closure date set out in the entity’s notice. At the public hearing, the board shall present information on alternative sources of pharmacy services available to impacted consumers and allow interested parties the opportunity to share comments and concerns about the proposed closure. Such interested parties may include, but not be limited to, impacted residents, municipal government officials, the members of the General Court who represent the municipality in which the pharmacy or pharmacy department is located, local health care providers, and neighborhood associations or other community associations.
And further amend the bill by inserting after section 29 the following section:-
SECTION 29A. Said chapter 118E is hereby further amended by striking out section 13L, as so appearing, and inserting in place thereof the following section:-
Section 13L. The secretary of health and human services, hereinafter “the secretary”, shall not take any actions, including through managed care entities as defined in section 13D½, that restrict or limit an eligible hospital’s access to the discounted purchase of prescription drugs to the full extent permitted under section 340B of the Public Health Service Act, as codified under 42 U.S.C. 256b unless the secretary provides the following not less than 180 days before the proposed effective date of the limitation or restriction: (i) notice to eligible hospitals of the proposed restriction or limitation; and (ii) a report with the joint committee on health care financing and the senate and house committees on ways and means detailing: (A) the proposed restriction or limitation; (B) the anticipated aggregate savings to the commonwealth; (C) the estimated fiscal impact of the restriction or limitation on each affected hospital; and (D) the manner in which the secretary plans to mitigate the fiscal impact, which may include measures to maintain savings already achieved by providers under said 42 U.S.C. 256b. Notwithstanding the preceding sentence, the secretary shall not designate greater than 25 prescription drugs at any given time to be restricted or limited from the discounts afforded to eligible hospitals under said 42 U.S.C. 256b; provided, that no prescription drug may be designated by the secretary unless the gross cost of such prescription drug is not less than $100,000 per utilizer per year; provided further, that no GLP-1 antagonist drug not already designated by the secretary as of July 1, 2024 shall be so designated.
And further amend the bill in section 35 by striking out, in lines 843 to 845, inclusive, the words “provided, that “pharmacy benefit manager” shall include a health benefit plan sponsor that does not contract with a pharmacy benefit manager and manages its own prescription drug benefits unless specifically exempted by the division.” and inserting in place thereof the following words:- provided, however, that “pharmacy benefit manager” shall not include a health benefit plan sponsor that (i) does not contract with a pharmacy benefit manager, (iii) manages its own prescription drug benefits, and (iii) is licensed as a carrier by the division.
And further amend the bill in section 36 by inserting after the word “pharmacies”, in line 976, the following words:- , in a form approved by the commissioner.
And further amend the bill in said section 36, in lines 1004 to 1006, inclusive, by striking out the words “The reimbursement amount shall be calculated on a per unit basis using the same Medi-Span generic product identifier or First DataBank generic code number.”
And further amend the bill in said section 36 by striking out, in lines 1011 to 1013, inclusive, the words “A carrier shall be jointly responsible to pay the surcharge amount for violations of this section by its contracted pharmacy benefit manager.”
And further amend the bill in said section 36 by inserting after the words “retroactive fees.”, in line 1021, the following sentence:- A carrier shall be jointly responsible to pay the surcharge amount for violations of this section by its contracted pharmacy benefit manager; provided, however, that a carrier shall not be jointly responsible to pay the surcharge amount for violations of this section by its contracted pharmacy benefit manager unless the contract between the carrier and the pharmacy benefit manager permits conduct prohibited by this section.
And further amend the bill in said section 36 by inserting after the word “carriers.”, in line 1101, the following sentence:- A pharmacy benefit manager shall annually report to the commissioner: (i) any state or federal enforcement action taken against the pharmacy benefit manager, and (ii) any civil or criminal process or investigation involving the pharmacy benefit manager within the previous calendar year.
And further amend the bill by inserting after section 37 the following 4 sections:-
SECTION 37A. (a) There shall be a special commission to study and make recommendations on the incidence and impacts of vitiligo and associated light-related diseases and disorders of pigmentation in the commonwealth. The special commission shall consist of: the secretary of the executive office of health and human services or a designee; the commissioner of public health or a designee; the commissioner of insurance or a designee; 2 persons to be appointed by the governor, 1 of whom shall be a primary care provider who treats patients diagnosed with vitiligo, and 1 of whom shall be a physician practicing dermatology and who treats patients diagnosed with vitiligo; 3 persons who shall be appointed by the senate president, 1 of whom shall be the senate chair of the joint committee on public health or a designee, 1 of whom shall be a member of the senate representing a community with an increased prevalence of vitiligo and 1 of whom shall be a patient with vitiligo; 1 member of the senate appointed by the senate minority leader; and 3 persons who shall be appointed by the speaker of the house of representatives, 1 of whom shall be the house chair of the joint committee on public health, or a designee, 1 of whom shall be a member of the house of representatives representing a community with an increased prevalence of vitiligo and 1 of whom shall be a representative of VITFriends Vitiligo Support Group, Inc. based in the Hyde Park neighborhood of the city of Boston.
(b) The special commission shall: (i) establish a mechanism in order to ascertain the prevalence of vitiligo and associated light-related diseases and disorders of pigmentation in the commonwealth; (ii) study successful models of patient and family education and support programs; (iii) survey the extent of health insurance coverage for treatment and services associated with vitiligo and recommend options to improve patient access to and awareness of innovative, affordable and beneficial treatments and services; and (iv) provide recommendations for additional legislation, support programs and resources necessary to meet the unmet needs of persons with vitiligo and their families.
(c) The special commission shall select by a majority vote a chairperson and vice-chairperson from among its members. The executive office of health and human services shall provide staff support to the commission. The public members shall serve without compensation, but shall be reimbursed for necessary expenses incurred in the performance of their duties.
(d) Not later than December 31, 2025, the commission shall submit the results of its study and its recommendations, if any, together with drafts of legislation necessary to carry its recommendations into effect, to the clerks of the house of representatives and the senate.
SECTION 37B. (a) For the purposes of this section, a “pharmacy desert” shall mean an area where there is no or limited access to pharmacies due to factors such as: (i) geographic location, specifically areas where the nearest pharmacy is more than 1 mile away in urban areas, more than 5 miles away in suburban areas and more than 10 miles away in rural areas; (ii) distance and travel time, defined as travel time exceeding 15 minutes by car or 30 minutes by public transportation; and (iii) limited access to transportation, both public and private, including areas with infrequent public transit services or where at least 20 per cent of the population lacks access to private vehicles.
(b) Notwithstanding any general or special law to the contrary, the health policy commission, in consultation with the board of registration in pharmacy and the center for health information and analysis, shall conduct an analysis and issue a report on pharmacy deserts, with the objective of identifying the number of pharmacy deserts in the commonwealth and barriers to access to medications for residents in urban and underserved areas. The analysis and report shall include, but not be limited to:
(i) an assessment on impacted neighborhoods and patient populations;
(ii) an assessment on the impact of pharmacy deserts on access to medications and health care outcomes;
(iii) an assessment of the geographical and financial barriers to obtaining medications faced by individuals living in pharmacy deserts;
(iv) an assessment of the average distance and travel time to a pharmacy from an impacted neighborhood, and the transportation options available;
(v) an assessment on the impact of pharmacy deserts on overall health care costs, including the costs of emergency department visits and hospitalizations;
(vi) an assessment on the impact of pharmacy benefit manager business practices in contributing to the closures of pharmacies across the commonwealth; and
(vii) policy recommendations to address current pharmacy deserts and limit the creation of new ones.
(c) Not later than February 1, 2025, the report shall be made available electronically on the health policy commission’s website and shall be filed with the clerks of the house of representatives and the senate, the house and senate committees on ways and means and the joint committee on health care financing.
SECTION 37C. (a) The health policy commission shall convene a task force to assess the feasibility of requiring that patient-specific prescription drug benefit and deductible information be made available by payers to requesting providers in real-time, at the point of prescribing, and the potential cost savings to patients as a result of such requirement.
(b) The task force shall consist of: the executive director of the health policy commission or designee, who shall serve as chair; the commissioner for the division of insurance or designee; the house and senate chairs of the joint committee on health care financing; and 5 persons to be appointed by the chair, 1 of whom shall be a representative from the Massachusetts Health and Hospital Association, Inc., 1 of whom shall be a representative from the Massachusetts Association of Health Plans, Inc., 1 of whom shall be a representative from Blue Cross and Blue Shield of Massachusetts, Inc., 1 of whom shall be representative from the Massachusetts Medical Society, and 1 of whom shall be a representative from the Massachusetts Pharmacists Association Corp.
(c) The task force shall submit a report on its findings, along with any legislative recommendations, to the clerks of the house of representatives and the senate and the joint committee on health care financing not later than December 31, 2025.
SECTION 37D. (a) There shall be a special commission to investigate and assess the feasibility of state-sponsored prescription drug manufacturing or distribution in the commonwealth. The special commission shall consist of: the secretary of health and human services or a designee, who shall serve as chair; the commissioner of insurance or a designee; the executive director of the center for health information and analysis or a designee; the executive director of the health policy commission or a designee; the president of the board of registration in pharmacy or a designee; the president of the University of Massachusetts or a designee; and 7 persons selected by the chair, 1 of whom shall be a representative of the Massachusetts Biotechnology Council, Inc., 1 of whom shall be a representative of the Massachusetts Health and Hospital Association, Inc., 1 of whom shall be an individual with expertise in biomedical research, 1 of whom shall be a physician licensed to practice medicine under section 2 of chapter 112 of the General Laws with expertise in the treatment of diabetes and related complications, 1 of whom shall be a physician licensed under said section 2 of said chapter 112 with expertise in the treatment of substance use disorders and related complications, 1 of whom shall be a physician licensed under said section 2 of said chapter 112 with expertise in the treatment of allergic reactions and related complications and 1 of whom shall be a physician licensed under said section 2 of said chapter 112 with expertise in the treatment of asthma and related complications.
(b) The special commission shall study and report on the feasibility of state-sponsored drug manufacturing or distribution in the commonwealth. The special commission shall: (i) study the feasibility of manufacturing commonly used pharmaceutical products and their analogs, including but not limited to insulin, naloxone, albuterol inhalers and epinephrine; (ii) assess the feasibility of providing the drug and drug analogs to low-income residents of the commonwealth at no-cost or at a reduced cost on a means-tested basis; (iii) assess the feasibility of partnerships between the commonwealth and other entities, including but not limited to, public universities and existing drug manufacturers, or partnerships between other appropriate entities and an existing drug manufacturer to leverage existing research and manufacturing capacity; (iv) study the example of the state of California’s state-sponsored drug manufacturing and distribution initiative; and (v) issue a report on the commission’s findings and policy recommendations.
(c) In its assessment, the commission shall consider the following factors: (i) the number of low-income residents who currently require the drugs listed in clause (i) of subsection (b); (ii) the ability of the commonwealth, the public university system or other appropriate entity, by themselves or in partnership with existing drug manufacturers, to produce the drugs listed in clause (i) of subsection (b); (iii) any long-term cost savings and revenue generation for the commonwealth; (iv) any long-term cost savings and other benefits to low-income residents of the commonwealth who would receive the drugs listed in clause (i) of subsection (b); (v) any costs to the commonwealth to produce the drugs listed in clause (i) of subsection (b), including additional administrative costs; (vi) state and federal regulatory or legal obstacles, including requirements for licensure, to the production and distribution of the drugs listed in clause (i) of subsection (b) within the commonwealth; (vii) available alternative methods for providing the drugs listed in clause (i) of subsection (b) to low-income residents of the commonwealth at low or no cost; (viii) options for capping copayments for the drugs listed in clause (i) of subsection (b) provided through private insurers; (ix) the potential for the commonwealth to engage in volume purchasing of the drugs listed in clause (i) of subsection (b) at reduced cost; (x) the mechanisms by which the commonwealth could establish a program to distribute the drugs listed in clause (i) of subsection (b) to residents of the commonwealth; (xi) opportunities to establish an interstate compact with other New England states to reduce costs; (xii) opportunities to establish a public entity to manage the manufacturing, purchasing or distribution of the drugs listed in clause (i) of subsection (b); (xiii) opportunities to establish a model facility to affordably manufacture the drugs listed in clause (i) of subsection (b); and (xiv) opportunities to procure dedicated funding to support the manufacture and distribution of the drugs listed in clause (i) of subsection (b) to residents of the commonwealth.
(d) Not later than September 1, 2025, the commission shall submit its report to the clerks of the house of representatives and the senate, the joint committee on health care financing and the joint committee on public health.