Section 21C: Point of sale charge for prescription drug; limit on amount of cost-sharing payment
[ Text of section added by 2024, 342, Sec. 27 effective April 8, 2025.]
Section 21C. (a) For the purposes of this section, the following words shall have the following meanings unless the context clearly requires otherwise:
"Cost-sharing'', an amount owed by an individual under the terms of the individual's health benefit plan.
"Health benefit plan'', as defined in section 1 of chapter 176O.
"Pharmacy benefit manager'', as defined in section 1 of chapter 176Y.
"Pharmacy retail price'', the amount an individual would pay for a prescription drug at a pharmacy if the individual purchased that prescription drug at that pharmacy without using a health benefit plan or any other prescription medication benefit or discount.
(b) At the point of sale, a pharmacy shall charge an individual for a prescription drug the lesser of: (i) the applicable cost-sharing amount; or (ii) the pharmacy retail price.
(c) A health benefit plan or carrier shall not require an insured to make a cost-sharing payment for a prescription drug in an amount greater than that charged pursuant to subsection (b).
(d) No contractual obligation between a pharmacy benefit manager and a pharmacist shall prohibit a pharmacist from complying with this section.