Budget Amendment ID: FY2027-S4-469

EHS 469

Study of Adopting a Single PBM for All MassHealth Plans

Ms. Creem and Ms. Rausch moved that the proposed new text be amended by adding the following section:-

"SECTION X. The health policy commission, in consultation with the executive office for health and human services, shall study whether the commonwealth should, for all MassHealth plans offered under chapter 118E, operate a single pharmacy benefit manager or contract with a single pharmacy benefit manager that is not under common ownership with a pharmacy or health plan and that is required to use pass-through pricing. The study shall consider the impact of such a change on: (i) costs to the state and to MassHealth patients; (ii) the quality of health care delivered to MassHealth patients; (iii) payments to and administrative burdens on pharmacies; (iv) the financial well-being of independent pharmacies; and (v) the number of pharmacies, including specialty pharmacies, available to MassHealth patients. In conducting the study, the health policy commission shall consider the experiences of states that have already adopted a single pharmacy benefit manager for Medicaid plans, including, but not limited to, New York, Ohio, Kentucky, Mississippi, Minnesota, Virginia, and Nevada. By not later than July 1, 2027, the health policy commission shall report the findings of its study, together with any recommendations for legislation or regulation, to the chairs of the joint committee on health care financing, the chairs of the joint committee on financial services, the chair of the Senate committee on ways and means, the chair of the House committee on ways and means, and the clerks of the House and Senate."