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HD 3763

An Act relative to MassHealth managed care pharmacy benefit reimbursement rates

194th Legislature (2025-2026) Introduced by Paul McMurtry

Replaces varied pharmacy reimbursements with a single standard: all MassHealth MCOs/ACOs pay pharmacies the rate in the MassHealth Pharmacy Provider Manual, enforced by regulators.

Senate concurred
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Bill Summary · HD 3763

Summary: Bill HD 3763 — An Act relative to MassHealth managed care pharmacy benefit reimbursement rates

Overview

HD 3763, introduced February 27, 2025, and currently in Senate concurrence status, would standardize how MassHealth managed care entities reimburse pharmacies. The bill amends Chapter 118E, Section 9C, to require all MassHealth Managed Care Organizations (MCOs) and Accountable Care Organizations (ACOs) to reimburse pharmacies at the same rate described in the MassHealth Pharmacy Provider Manual. It also directs state regulators to issue regulations to enforce these provisions.

Key Provisions

  • Amended provision: Section 9C of Chapter 118E is augmented to require:
    • All MassHealth MCOs and ACOs must reimburse pharmacies at the same rate described in the MassHealth Pharmacy Provider Manual.
  • Regulatory enforcement: The Commissioner of the Division of Insurance and the Secretary of Health and Human Services must promulgate regulations to enforce the bill’s provisions.

Affected Parties

  • Primary: MassHealth Managed Care Organizations and MassHealth Accountable Care Organizations, which administer pharmacy benefits within MassHealth.
  • Pharmacies: Community and/or outpatient pharmacies that serve MassHealth beneficiaries, as their reimbursement terms would be set to align with the MassHealth Pharmacy Provider Manual.
  • MassHealth beneficiaries: Indirectly affected through the consistency and predictability of pharmacy reimbursements, potentially impacting access and out-of-pocket costs.
  • State agencies: Division of Insurance and the Department of Health and Human Services (via the mandated regulations and enforcement).

Implementation and Timeline

  • Regulatory action: The bill requires new regulations to be promulgated by the Commissioner of the Division of Insurance and the Secretary of Health and Human Services to enforce the reimbursement parity.
  • Timeline specifics: The text does not prescribe a concrete effective date or transition period; regulatory rulemaking typically follows enactment, subject to standard administrative processes.

Procedural History

  • Introduced: February 27, 2025 (House Docket No. 3763, House No. 1390), sponsored by Rep. Paul McMurtry.
  • Legislative actions:
    • Senate concurred on February 27, 2025.
    • Referred to the Senate committee on Health Care Financing (same date).
  • Status: Senate concurrence achieved; bill moving through standard committee review and potential further action.

Possible Impacts and Considerations

  • Standardization: Promotes uniform reimbursement across MassHealth MCOs and ACOs, reducing payer variability for pharmacies.
  • Financial effects: Could affect overall MassHealth drug benefit costs depending on current disparate reimbursement rates and the MassHealth Pharmacy Provider Manual’s terms.
  • Access and stability: May improve predictability for pharmacies and beneficiaries, potentially supporting stable access to prescribed medications.
  • Regulatory burden: Adds a requirement for regulatory rulemaking and ongoing enforcement by state agencies.

Sponsors

  • Primary sponsor: Rep. Paul McMurtry (with petition by Rep. McMurtry and Rep. Vanna Howard).

This summary captures the bill’s core purpose, provisions, affected entities, and key procedural steps to date.

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

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