On Jan. 9, MA LEG passed bill on health care access, lower costs.
MA LEG passed bill SB 3012 on pharmaceutical access, costs and transparency.
Insurers must eliminate cost-sharing requirements for 1 generic drug and cap co-pays on 1 brand-name drug at $25 per 30-day supply for diabetes, asthma, heart conditions
Concurrently passed HB 5159 to enhance the market review process, see #239635.
Bill Provisions
Bill provisions include comprehensive reforms to lower the cost of prescription drugs and improve oversight of the pharmaceutical industry, market conduct by PBMs.
SB 3012 requires insurers to eliminate the cost-sharing requirements for one generic drug and to cap the co-payments on one brand-name drug at $25 per 30-day supply.
For diabetes, asthma, certain heart conditions; provided drug selection considerations.
Ensures consumers are not charged co-pay if cheaper to purchase drug without using insurance, requires continuity of coverage for prescriptions when switching to new plan
Requires insurance carriers report drug selections to the division on an annual basis.
Imposes restrictions on payments by PBMs to pharmacy benefit consultants or brokers if consultants, brokers worked on the pharmacy benefit bidding or contracting process.
Codified MA INS I-XXII-176Y, licensing and regulation of pharmacy benefit managers.
Due to disagreeing votes of the two branches with reference to a House amendment of bill SB 2520 (formerly SB 2499), chambers passed accompanying bill, SB 3012.
On Dec. 30, 2024, bill reported to Senate; on Dec. 30, 2024, bill passed by Senate.
On Dec. 30, 2024, bill was introduced in House; on Dec. 30, 2024, bill passed House.
On Jan. 9, 2025, governor signed bill into law, assigned Ch. 342 of the Acts of 2024.
Effectiveness
Assessments in Section 6 shall apply to budgets for health policy commission and the center for health information and analysis, respectively, beginning in fiscal year 2026.
Sections 26, 28, 31, 33, 34 and 35 shall apply to all contracts on or after Jul. 1, 2025.
Commissioner of Insurance shall promulgate regulations to implement Chapter 176Y not later than Oct. 1, 2025, PBMs to be licensed in accordance by Jan. 1, 2026.
