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H 1390

An Act relative to MassHealth managed care pharmacy benefit reimbursement rates

194th Legislature (2025-2026) Introduced by Vanna Howard and 1 co-sponsor

Requires all MassHealth MCOs and ACOs to reimburse pharmacies at the MassHealth Pharmacy Provider Manual rate, with new regulations to enforce consistent payments.

Reporting date extended to Friday, July 31, 2026
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Bill Summary · H 1390

Summary: H.1390 An Act relative to MassHealth managed care pharmacy benefit reimbursement rates

Purpose and intent

  • The bill seeks to standardize howMassHealth managed care organizations (MCOs) and Accountable Care Organizations (ACOs) reimburse pharmacies for medications dispensed to MassHealth members.
  • Specifically, it requires reimbursement to pharmacies at the rate described in the MassHealth Pharmacy Provider Manual and directs state agencies to establish enforcement regulations.

Key provisions

  • Amend Section 9C of Chapter 118E of the General Laws by adding at the end:
    • “All MassHealth Managed Care Organizations and Accountable Care Organizations are required to reimburse pharmacies at the same rate as described in the MassHealth Pharmacy Provider Manual.”
  • Regulatory framework:
    • The Commissioner of the Division of Insurance and the Secretary of Health and Human Services must promulgate regulations to enforce the provisions of this act.

Affected parties

  • Primary beneficiaries:
    • MassHealth enrollees who access medications through MCOs or ACOs.
  • Impacted entities:
    • MassHealth Managed Care Organizations and MassHealth Accountable Care Organizations (reimbursement practices).
    • Pharmacies that participate in MassHealth networks.
    • State regulatory bodies: Division of Insurance and the Department of Health and Human Services (for enforcement regulations).

Procedural and timeline aspects

  • Status and timeline:
    • Introduced: February 27, 2025.
    • Filed as House Docket No. 3763; House No. 1390.
    • Referred to the Committee on Health Care Financing.
    • Hearing scheduled: July 15, 2025 (Gardner Auditorium), 10:00 AM–4:00 PM.
    • Government action: Senate concurred; reporting date extended multiple times.
    • Current reporting date extension: extended until Wednesday, March 18, 2026.
  • Legislative actions noted:
    • 2025-02-27: Referred to committee.
    • 2025-02-27: Senate concurred.
    • 2025-10-08: Reporting date extended to March 18, 2026.
  • Related measure:
    • Related HD 3763 (House version that is described as replacing it).

Potential impacts

  • Access and affordability: Aims to minimize variability in pharmacy reimbursements, potentially improving access to medications for MassHealth members.
  • Pharmacy revenue: Could stabilize or constrain reimbursement levels to those in the MassHealth Pharmacy Provider Manual, affecting pharmacy margins and pricing strategies.
  • Administrative: Requires regulatory development and enforcement mechanisms by the Division of Insurance and the Department of Health and Human Services.

Additional notes

  • The bill includes a defined enforcement mechanism but leaves the exact regulatory details to subsequent regulations.
  • The sponsor and cosponsor are Rep. Paul McMurtry (primary) and Rep. Vanna Howard (cosponsor).

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

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