Amendment #1634 to H5500
Pharmaceutical Manufacturer Assessment
Mr. Lawn of Watertown moves to amend the bill by adding the following sections:-
SECTION XX. Section 6 of Chapter 6D of the General Laws, as appearing in the 2024 Official Edition, is hereby amended by striking out subsection (d) and inserting in place thereof the following subsection:-
(d) To the maximum extent permissible under federal law, and provided that such assessment will not result in any reduction of federal financial participation in Medicaid, the assessed amount for pharmaceutical manufacturing companies shall be not less than 5 per cent nor more than 10 per cent of the amount appropriated by the general court for the expenses of the commission minus amounts collected from: (i) filing fees; (ii) fees and charges generated by the commission; and (iii) federal matching revenues received for these expenses or received retroactively for expenses of predecessor agencies. Each pharmaceutical manufacturing company shall annually pay such assessed amount multiplied by the ratio of the manufacturer’s net prescription drug spending for the prior calendar year, as determined by the commission based on available data from all-payer claims data reflecting prescription drug utilization in the commonwealth, to total prescription drug spending reflected in such all-payer claims data for the prior calendar year. For purposes of this paragraph, the manufacturer’s net prescription drug spending shall equal total spending for the manufacturer’s prescription drugs for payors reporting such pharmacy claims data to the center for the prior calendar year, minus all rebates, in the aggregate, paid by the manufacturer with respect to such prescription drugs, as reported to the center for health information and analysis pursuant to section 10A of said chapter 12C. All amounts collected pursuant to this subsection shall be deposited into the Pharmaceutical and Pharmacy Benefit Manager Data and Oversight Fund established in section 2OOOOOO of chapter 29.
SECTION XX. Said section 6 of said chapter 6D, as so appearing, is hereby further amended by inserting after subsection (f) the following subsection:-
(g) Data and information submitted to or collected by the commission pursuant to this section that identify or could reasonably be used to identify the pricing, rebates, discounts or other financial arrangements of a pharmaceutical manufacturing company or pharmacy benefit manager, including any individual assessment amount or calculation made under this section, shall be confidential and shall not be public records under clause twenty-sixth of section 7 of chapter 4 or subject to disclosure under chapter 66; provided that nothing in this section shall prohibit the commission from providing any such entity access to information relating to that entity’s own assessed amount and the basis for such assessment. The commission may publish aggregated or de-identified information derived from such data that does not identify, or permit the identification of, any individual pharmaceutical manufacturing company, pharmacy benefit manager or other entity.
SECTION XX. Section 7 of chapter 12C, as so appearing, is hereby amended by striking out subsection (d) and inserting in place thereof the following subsection:-
(d) To the maximum extent permissible under federal law, and provided that such assessment will not result in any reduction of federal financial participation in Medicaid, the assessed amount for pharmaceutical manufacturing companies shall be not less than 5 per cent nor more than 10 per cent of the amount appropriated by the general court for the expenses of the center minus amounts collected from: (i) filing fees; (ii) fees and charges generated by the center; and (iii) federal matching revenues received for these expenses or received retroactively for expenses of predecessor agencies. Each pharmaceutical manufacturing company shall annually pay such assessed amount multiplied by the ratio of the manufacturer’s net prescription drug spending for the prior calendar year, as determined by the center based on available data from all-payer claims data reflecting prescription drug utilization in the commonwealth, to total prescription drug spending reflected in such all-payer claims data for the prior calendar year. For purposes of this paragraph, the manufacturer’s net prescription drug spending shall equal total spending for the manufacturer’s prescription drugs for payors reporting such pharmacy claims data to the center for the prior calendar year, minus all rebates, in the aggregate, paid by the manufacturer with respect to such prescription drugs, as reported to the center pursuant to section 10A of said chapter 12C. All amounts collected pursuant to this subsection shall be deposited into the Pharmaceutical and Pharmacy Benefit Manager Data and Oversight Fund established in section 2OOOOOO of chapter 29.
SECTION XX. Said section 7 of said chapter 12C, as so appearing, is hereby further amended by inserting after subsection (f) the following subsection:-
(g Data and information submitted to or collected by the center pursuant to this section that identify or could reasonably be used to identify the pricing, rebates, discounts or other financial arrangements of a pharmaceutical manufacturing company or pharmacy benefit manager, including any individual assessment amount or calculation made under this section, shall be confidential and shall not be public records under clause twenty-sixth of section 7 of chapter 4 or subject to disclosure under chapter 66; provided that nothing in this section shall prohibit the center from providing any such entity access to information relating to that entity’s own assessed amount and the basis for such assessment. The center may publish aggregated or de-identified information derived from such data that does not identify, or permit the identification of, any individual pharmaceutical manufacturing company, pharmacy benefit manager or other entity.
SECTION XX. Chapter 29 of the General Laws, as so appearing, is hereby amended by inserting after section 2NNNNNN the following section:-
Section 2OOOOOO. (a) There shall be established and set up on the books of the commonwealth a separate fund to be known as the Pharmaceutical and Pharmacy Benefit Manager Data and Oversight Fund, hereinafter referred to as the fund. The fund shall be administered by the secretary of administration and finance.
(b) The fund shall consist of: (i) amounts collected pursuant to sections 6 of chapter 6D and section 7 of chapter 12C; (ii) any interest earned on such amounts; and (iii) any other amounts credited or transferred to the fund.
(c) Amounts credited to the fund shall be expended, without further appropriation, by the health policy commission established under chapter 6D and the center for health information and analysis established under chapter 12C for the purposes of carrying out their respective duties related to the oversight, analysis, data collection and reporting of pharmaceutical manufacturing companies and pharmacy benefit managers, including pharmacy benefit manager-affiliated entities.
(d) The secretary of administration and finance shall allocate amounts from the fund to the health policy commission and the center for health information and analysis in a manner that reflects the relative costs incurred by each entity in carrying out the purposes of the fund.
(e) Amounts remaining in the fund at the end of a fiscal year shall not revert to the General Fund and shall be available for expenditure in subsequent fiscal years.
(f) The health policy commission and the center for health information and analysis shall, in consultation with the secretary of administration and finance, adopt any regulations or procedures necessary to implement this section.