Amendment ID: S2499-40-R1

Redraft Amendment 40

Relative to Specialty Pharmacy

Messrs. Feeney and Pacheco, Ms. Moran and Messrs. Brady, Keenan, Timilty and Velis move that the proposed new draft be amended by striking out section 49 and inserting in place thereof the following section:-

“SECTION 49. The fourth paragraph of section 3B of chapter 176D of the General Laws, as appearing in the 2022 Official Edition, is hereby amended by inserting after the second sentence the following sentence:- Neither a carrier nor the group insurance commission may prohibit the dispensing of a specialty drug that is included in its pharmaceutical drug benefits to an insured by any network specialty pharmacy licensed under section 39K of chapter 112; provided, however, that the pharmacy: (i) agrees to the in-network reimbursement rate for the specialty drug; (ii) is able to comply with the standards for special handling, administration, quality, safety and monitoring established under subsection (c) of said section 39K of said chapter 112; and (iii) complies with all reasonable carrier network terms and conditions for dispensing the specialty drug; provided further, that neither a carrier nor the group insurance commission may impose any terms or conditions on a specialty pharmacy licensed under said section 39K of said chapter 112 that are unreasonable or prevent the specialty pharmacy from providing the specialty drug; provided further, that the commissioner may grant a waiver exempting a carrier from the requirements of this sentence to a carrier whose percentage of members enrolled in government programs is 80 per cent or more, as indicated in the most recent enrollment data published by the center for health information and analysis; and provided further, that the term “carrier” as used in this sentence shall apply to the division of medical assistance to the extent allowed under federal law.”; and

in section 43 by inserting after the word “section”, in line 861, the following words:-“; and provided further, that the board shall consult with industry leaders and experts and shall base said policies, procedures or regulations on best evidence-based practices.”