Amendment #319 to H4000

Administration of MassHealth Pharmacy Benefits

Ms. Kerans of Danvers moves to amend the bill by adding the following section:

“SECTION XXXX. The Executive of Health and Human Services shall conduct a study to determine the feasibility and potential benefit to the commonwealth of transferring the administration of pharmacy benefits from MassHealth managed care providers to the MassHealth fee-for-service pharmacy program or through the selection of a single claims processor for the pharmacy benefits provided by managed care providers. The analysis shall determine the amount of savings that would be realized by the Commonwealth due to the use of the Medicaid drug price reimbursement formula, an increase in the receipt of prescription drug rebates and other program efficiencies that could result from the single administration of the pharmacy benefit for MassHealth recipients. The report shall analyze the savings from those states that have moved the administration of the pharmacy benefits from the Medicaid managed care organizations back into their Medicaid fee-for-service pharmacy program or have selected a single claims process administrator and shall also consider the total savings from converting to NADAC price for the cost of drugs and MassHealth’s professional dispensing fee. The Secretary shall transmit the report to the chairs of the House and Senate Committees on Ways and Means and the chairs of the Joint Committee on Health Care Financing not later than October 1, 2025."

Additional co-sponsor(s) added to Amendment #319 to H4000

Administration of MassHealth Pharmacy Benefits