MA H1334

Creates new Chapter 175N establishing a "pharmacy benefit manager duty of care" requiring PBMs to perform services with care, skill, prudence, diligence, fairness, transparency, and professionalism in the best interests of enrollees, health benefit plans, and providers

Establishes a hierarchy of duties when conflicts arise: obligations to enrollees take priority over all other parties, and duties to providers take priority over duties to health benefit plans

Requires PBMs to provide transparency about amounts charged or claimed, sufficient to identify instances of "spread pricing" (charging more than the drug ingredient cost plus dispensing fee minus management fees)

Mandates disclosure of all conflicts of interest to enrollees, health benefit plans, and providers

Authorizes the Commissioner of Insurance to issue monetary penalties, suspend or revoke PBM licenses, and establish regulations for administrative appeals of enforcement actions