MA H4346

Pharmacy benefits managers (PBMs) must ensure maximum allowable cost reimbursements to pharmacies equal or exceed the pharmacy's acquisition cost, with National Average Drug Acquisition Cost serving as the compliance benchmark

Drugs placed on maximum allowable cost lists must be FDA "A" or "AB" rated (or equivalent) with at least two therapeutically equivalent versions available from wholesalers; non-compliant drugs must be removed within 3 business days

PBMs must update maximum allowable cost lists every 3 business days, provide contracted pharmacies access to pricing sources and lists, and apply updated costs to payments within 2 business days

Pharmacies may appeal drug reimbursement rates within 7 business days, with PBMs required to resolve appeals within 7 business days and retroactively adjust payments for valid appeals across all similar network pharmacies

MassHealth Managed Care Organizations and Accountable Care Organizations must reimburse pharmacies at standard MassHealth rates; pharmacists cannot be prohibited or penalized for disclosing cost-share information or more affordable drug alternatives to patients