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H 1202

An Act establishing a commission to study maximum allowable costs lists

194th Legislature (2025-2026) Introduced by Kim Ferguson and 3 co-sponsors

Massachusetts establishes a commission to study how maximum allowable cost lists affect medication pricing, pharmacy reimbursements, and patient drug access.

Accompanied a study order, see H5223
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Bill Summary · H 1202

Legislative bill overview

H.1202 establishes a commission to study maximum allowable costs (MAC) lists in Massachusetts, which are pricing benchmarks used by insurance plans and pharmacy benefit managers to determine reimbursement rates for medications. The bill directs this commission to examine how MAC lists affect drug pricing, patient access, and pharmacy operations, presumably to inform future policy decisions.

Why is this important

MAC lists significantly influence medication costs and which drugs pharmacies can profitably dispense. This study could reveal whether current MAC pricing practices are creating barriers to medication access, unfairly reducing pharmacy reimbursements, or inflating costs for patients and insurers—potentially leading to regulatory or legislative reforms.

Potential points of contention

  • Pharmacy industry support vs. payer concerns: Pharmacies often advocate for higher MAC reimbursement rates, while insurance plans argue current rates are necessary for cost control; the commission's findings could favor one side over the other
  • Definition and scope ambiguity: The bill doesn't clarify which MAC list practices the commission will examine (frequency of updates, methodology, transparency) or whether recommendations will be binding
  • Timeline and implementation uncertainty: The bill schedules a hearing but provides no deadline for the commission's final report, meaning findings could take years to translate into actual policy changes

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

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