MA H1234

Carriers and pharmacy benefit managers must pass through at least 80% of estimated drug rebates to insured patients at the point of sale by reducing cost-sharing amounts

Prohibits spread pricing, where pharmacy benefit managers charge health plans more for drugs than they pay pharmacies; violators face a 10% surcharge on aggregate pharmacy reimbursements

Pharmacy benefit managers must update maximum allowable cost lists at least every 7 days and provide pharmacies a formal grievance process with 30 business days to respond to challenges

Prohibits retroactive reduction of pharmacy reimbursements after clean claim adjudication, except for fraud or routine audit findings

Carriers must file annual compliance reports by April 1; noncompliance penalties up to $5,000 per day; pharmacists cannot be prohibited from informing patients about cost-sharing amounts or more affordable drug alternatives