Massachusetts H 4346: Extension Order H.4346

Bill Text

HOUSE . . . . . . . . No. 4346

The Commonwealth of Massachusetts

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HOUSE OF REPRESENTATIVES, July 31, 2025.
The committee on Financial Services, to whom was referred the
petition (accompanied by bill, House, No. 1326) of Alan Silvia for
legislation to ensure access to prescription medications, reports
recommending that the accompanying bill (House, No. 4346) ought to
pass.

For the committee,

JAMES M. MURPHY.

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FILED ON: 7/25/2025
HOUSE . . . . . . . . . . . . . . . No. 4346

The Commonwealth of Massachusetts

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In the One Hundred and Ninety-Fourth General Court
(2025-2026)
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An Act to ensure access to prescription medications.

Be it enacted by the Senate and House of Representatives in General Court assembled, and by the authority
of the same, as follows:

1 SECTION 2. Chapter 176D of the General Laws, is hereby amended by adding, after
2 section 3B, the following section:-
3 Section 3C. (a) For the purposes of this section the term "maximum allowable cost list"
4 shall mean a list of drugs, medical products or devices, or both medical products and devices, for
5 which a maximum allowable cost has been established by a pharmacy benefits manager or
6 covered entity. The term "maximum allowable cost" shall mean the maximum amount that a
7 pharmacy benefits manager or covered entity will reimburse a pharmacy for the cost of a drug or
8 a medical product or device inclusive of all discounts when the claim is processed or taken
9 retroactively
10 (b) Before a pharmacy benefits manager or covered entity may place a drug on a
11 maximum allowable cost list the drug must be listed as "A" or "AB" rated in the most recent
12 version of the FDA's Approved Drug Products with Therapeutic Equivalence Evaluations, also
13 known as the Orange Book, or has an "NR" or "NA" rating or a similar rating by a nationally

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14 recognized reference; and that there are at least two therapeutically equivalent, multiple source
15 drugs, or at least one generic drug available from one manufacturer, available for purchase by
16 network pharmacies from national or regional wholesalers.
17 (c) If a drug that has been placed on a maximum allowable cost list no longer meets the
18 requirements of subsection (a), the drug shall be removed from the maximum allowable cost list
19 by the pharmacy benefits manager or covered entity within 3 business days after the drug no
20 longer meets the requirements of subsection (a).
21 (d) A pharmacy benefits manager or covered entity shall make available to each
22 pharmacy with which the pharmacy benefits manager or covered entity has a contract and to
23 each pharmacy included in a network of pharmacies served by a pharmacy services
24 administrative organization
25 with which the pharmacy benefits manager or covered entity has a contract, at the
26 beginning of the term of a contract upon renewal of a contract, or upon request:
27 (1) The sources used to determine the maximum allowable costs for the drugs and
28 medical products and devices on each maximum allowable cost list;
29 (2) Every maximum allowable cost for individual drugs used by that pharmacy benefits
30 manager or covered entity for patients served by that contracted pharmacy; and
31 (3) Upon request, every maximum allowable cost list used by that pharmacy benefits
32 manager or covered entity for patients served by that contracted pharmacy.
33 (e) A pharmacy benefits manager or covered entity shall:

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34 (1) Ensure the maxim allowable cost (if used) or the ingredient cost (if not used) is equal
35 to or greater than the pharmacies acquisition cost for all covered medications. A maximum
36 allowable cost equal to or greater than the National Average Drug Acquisition Cost shall be
37 deemed in compliance with the requirement to ensure it is greater than or equal to the pharmacies
38 acquisition cost. (2) Ensure the maximum allowable cost for non-affiliated pharmacies is equal to
39 or greater than the maximum allowable cost to pharmacies affiliated with or owned by the
40 pharmacy benefit manager.
41 (3) The pharmacy benefit manager shall update each maximum allowable cost list at least
42 every 3 business days (4) Make the updated lists available to every pharmacy with which the
43 pharmacy benefits manager or covered entity has a contract and to every pharmacy included in a
44 network of pharmacies served by a pharmacy services administrative organization with which
45 the pharmacy benefits manager or covered entity has a contract, in a readily accessible, secure
46 and usable web-based format or other comparable format or process; and
47 (5) Utilize the updated maximum allowable costs to calculate the payments made to the
48 contracted pharmacies within 2 business days.
49 (f) A pharmacy benefits manager or covered entity shall establish a clearly defined
50 process through which a pharmacy may contest the cost for a particular drug or medical pro