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S 3103

Amendment S.3103

194th Legislature (2025-2026) Introduced by Mike Moore and 1 co-sponsor

Massachusetts will require nonprofit hospitals to disclose drug chargemaster pricing for review by authorities to determine reasonableness and potential excessiveness impacting aff

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Bill Summary · S 3103

Summary of Bill S.3103 (Amendment to Senate Ways and Means Amendment)

Purpose and intent

  • The amendment adds a new framework within Massachusetts law to review nonprofit hospital chargemaster drug pricing for reasonableness and potential excessiveness.
  • It establishes a structured process for data disclosure, analysis, and potential enforcement to address high drug prices charged by nonprofit hospitals.

Key provisions and changes

  • New Section 8B — Review of nonprofit hospital drug chargemaster pricing (Chapter 6D):

    • The Health Policy Commission can require a nonprofit hospital to disclose detailed chargemaster information for drugs identified in referrals.
    • Required disclosures (on a standard form) include:
    • Pricing methodology and historical price increases (past 5 years)
    • Narrative factors behind pricing
    • Acquisition benchmarks, reimbursement benchmarks, and internal pricing rationale
    • Whether drugs are 340B-acquired and how that affects pricing
    • Whether different pricing methods are used for 340B vs non-340B or comparable drugs
    • Any other relevant information
    • Confidentiality protections:
    • Disclosures must be attested as true
    • Data may be kept confidential if it contains trade secrets or proprietary information
    • Public reports may summarize findings without disclosing specific supplier prices or other protectable data
    • Determination of reasonableness/excessiveness:
    • If pricing may be unreasonable/excessive (e.g., chargemaster exceeds 120% of ASP or is higher than peers), the Commission must request additional information with at least 30 days’ notice
    • Considerations for review include price relationships to ASP and acquisition costs, payer-specific reimbursements, patient cost-sharing, 340B distinctions, differential treatment vs. other hospitals, and alignment with charitable mission and affordability
    • Timeline: Commission must issue a written report within 180 days of receiving requested information
    • Public reporting: Reports published online describing drugs reviewed and recommendations, without disclosing protected data

  • New Section 8C — Attorney General enforcement considerations (Chapter 6D):

    • After the Commission’s report, the Attorney General can review materials and determine whether to open an investigation.
    • If warranted, the AG may investigate whether chargemaster pricing remains the same or substantially similar to the Commission-found pricing.
    • The hospital can submit a certification detailing whether the markup benefits patients (e.g., lower out-of-pocket costs) and how substantial and automatic such benefits are.
    • If continued pricing is found to be unfair or deceptive, it may lead to enforcement under Chapter 93A (unfair or deceptive acts or practices) including injunctive relief, restitution, penalties, and fees.
    • Certifications do not immunize the hospital from further investigation or enforcement if warranted.

  • New Section 10B — Center for Health Information and Analysis (CHIA) nonprofit hospital drug chargemaster reporting and referrals (Chapter 12C):

    • Annual Drug Chargemaster Pricing Methodology Report:
    • Hospitals must describe their chargemaster pricing methodology in detail, including:
      • Drug pricing categories, inputs (acquisition cost, ASP, etc.), and the exact pricing formula or multipliers
      • Updates and changes in pricing methodology, site-specific variations, and payer-specific differences
      • Responsible officers or committees and governance around pricing
      • Changes made in the preceding year and a hypothetical pricing illustration
      • Policies on 340B vs non-340B pricing
      • Certification by the hospital’s CFO or equivalent
    • Annual Drug Pricing Supplemental Schedule for the top drugs (by reimbursement) including:
      • Drug identifiers, chargemaster amounts, pricing category, 340B status, effective date of changes, ASP, and whether charges exceed 120% of ASP
    • Confidentiality and public reporting:
    • Data remains confidential where appropriate, with CHIA producing public summaries that do not reveal sensitive data
    • Regulatory and administrative details:
    • CHIA will promulgate regulations to implement reporting, including formats, material change definitions, audit procedures, and redaction standards
    • Filing deadlines:
    • Reports and supplemental schedules must be filed by March 31 for the preceding year
    • Hospitals must update filings within 30 days of any material change
    • Penalties for noncompliance:
    • Civil penalties scale from $10,000 for an initial violation to $50,000 for each subsequent violation within 3 years
    • Daily violations may accrue after notice and cure period

Who would be affected

  • Nonprofit hospitals operating in Massachusetts that set chargemaster prices for drugs (including outpatient clinics and related affiliates)
  • The Center for Health Information and Analysis (CHIA)
  • The Health Policy Commission
  • Massachusetts Attorney General
  • Health care payers (commercial insurers, Medicare Advantage, Medicaid managed care) and patients (indirectly, through potential pricing and affordability considerations)
  • Hospital patients and consumer advocates, who would benefit from greater transparency and potential price relief

Procedural and timeline aspects

  • Referral-driven process: CHIA identifies drugs for review and forwards information to the Health Policy Commission
  • Commission action: Up to 180 days to issue a findings report on each reviewed drug
  • AG involvement: Post-Commission report, AG can open investigations and pursue enforcement if warranted
  • Annual reporting cycle:
    • CHIA collects and reviews methodology reports and supplemental schedules by March 31 each year
    • Referrals to the Commission for review if any drug exceeds 120% of ASP or raises concerns
    • Public summaries produced by CHIA while protecting sensitive prices
  • Penalty structure for noncompliance with reporting requirements

Notable details

  • The threshold of concern referenced includes chargemaster amounts exceeding 120% of ASP and discrepancies relative to similar hospitals
  • Emphasis on patient affordability and how pricing may or may not translate into direct patient benefits
  • Protections to safeguard proprietary cost information while enabling regulatory oversight

This bill aims to increase transparency and oversight of nonprofit hospital drug pricing in Massachusetts, with a pathway for Commission review, AG enforcement, and CHIA-led reporting, all focused on determining whether chargemaster pricing is unreasonable or excessive and whether such pricing impacts patient affordability.

Compiled from official sources — confirm details with the bill’s official record.

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