MA H4493

Pharmacy benefit managers (PBMs) must pay pharmacies dispensing fees no less than Massachusetts Medicaid rates and ingredient costs equal to or greater than Medicaid program costs, with retroactive rate reductions like "Generic Effective Rate" prohibited

PBMs cannot engage in "pharmacy steering" that channels prescriptions to pharmacies they own, and must pay non-affiliated pharmacies equal to or more than affiliated pharmacies

Any Massachusetts-licensed pharmacy willing to meet service requirements must be allowed to dispense specialty medications; requirements cannot be designed to exclude community pharmacies

Maximum allowable cost lists must be updated every 3 business days, with a 7-business-day appeals process for pharmacies to contest drug pricing; successful appeals trigger retroactive reimbursement and network-wide price adjustments within 3 days

Insurance Commissioner granted enforcement authority to examine PBM records, with PBMs required to submit annual reports on denied pharmacy appeals; PBMs prohibited from charging community pharmacies for credentialing