MA H1324

Requires pharmacy benefits managers (PBMs) to obtain a license from the Commissioner of Insurance to operate in Massachusetts, with application requirements including a surety bond and agent for service of process

Mandates PBMs disclose to covered entities the difference between amounts paid to pharmacies and amounts billed to plan sponsors for prescription services

Establishes Maximum Allowable Cost (MAC) pricing requirements, including updating pricing at least every 7 calendar days and only listing drugs rated "A" or "B" in the FDA Orange Book that are available from wholesalers

Creates a reimbursement appeals process allowing pharmacies to contest payment amounts within 14 business days, with PBMs required to respond within 10 business days and adjust pricing retroactively if appeals are upheld

Permits pharmacies to decline services if reimbursement falls below their cost, and prohibits PBMs from requiring accreditation beyond state pharmacy board or federal licensing as a condition for network participation