Amendment #5 to H5699

Protecting 340B MassHealth Providers

Mrs. Lipper-Garabedian of Melrose moves to amend the bill by adding the following section:

“SECTION XXXX. Notwithstanding any general or special law to the contrary, until 120 days after the date on which the Centers for Medicare & Medicaid Services approves a successor agreement resolving the commonwealth’s pending request to renew the MassHealth Section 1115 Demonstration and the associated special terms and conditions have been accepted by the commonwealth, the executive office of health and human services shall not, directly or through a managed care entity, implement any limitation, restriction, prohibition, or material alteration concerning MassHealth pharmacy coverage or reimbursement that was not in effect on July 31, 2026, including any policy that restricts reimbursement or coverage for a drug acquired through the federal 340B Drug Pricing Program under 42 U.S.C. § 256b or that removes pharmacy coverage from, or otherwise materially alters pharmacy coverage under, a MassHealth managed-care arrangement; provided further, a temporary, technical, or bridge extension approved for the purpose of maintaining the 1115 Demonstration while renewal negotiations continue shall not constitute approval of a successor agreement for purposes of this section; provided further, that not later than December 31, 2027, the executive office shall submit a report to the joint committee on health care financing and the house and senate committees on ways and means including but not limited to: (i) the fiscal, operational, and patient access impacts of any proposed changes to MassHealth pharmacy services; (ii) the projected gross and net state and federal fiscal effects of said proposed changes, including all underlying assumptions, methodology, and anticipated timeframes; (iii) the amount, source, duration, and federal matching treatment of any mitigation funding; and (iv) the financial and operational impact on federally qualified community health centers and hospitals, including but not limited to changes in drug acquisition costs, cash flow implications, reimbursement variability, associated risks to providers including potential financial losses, and the administrative and operational burdens for health care providers to implement proposed changes”.

Additional co-sponsor(s) added to Amendment #5 to H5699

Protecting 340B MassHealth Providers