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S 827

Establishes the rural emergency first responder program revolving fund

2025 Regular Session Introduced by Patrick Gallivan and 1 co-sponsor

Requires PBMs to set MACs no lower than pharmacy acquisition cost, with transparent MAC lists, frequent updates, and a rapid appeal process for pharmacies.

REFERRED TO HEALTH
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Bill Summary · S 827

Summary — S.827 (2025) — “An Act to ensure access to prescription medications”

Note: the bill metadata provided includes a conflicting short title (“Establishes the rural emergency first responder program revolving fund”) and sponsor list that appear inconsistent with the bill text. This summary is based on the bill text filed as “An Act to ensure access to prescription medications,” which adds a new Section 3C to Massachusetts General Laws Chapter 176D concerning pharmacy benefits managers (PBMs) and maximum allowable cost (MAC) lists.

Purpose

To increase transparency and fairness in how PBMs and covered entities set and apply maximum allowable costs (MACs) for drugs, medical products and devices paid through pharmacy benefits — with the aim of ensuring pharmacies are reimbursed at or above their acquisition cost and providing a prompt, enforceable appeals process for pharmacies.

Key definitions

  • “Maximum allowable cost list” (MAC list): list of drugs/products for which a MAC is established.
  • “Maximum allowable cost” (MAC): the maximum reimbursement amount a PBM/covered entity will pay a pharmacy for a drug/product inclusive of all discounts.

Major provisions

  • Eligibility for inclusion on a MAC list: a drug must be A or AB rated in the FDA Orange Book (or equivalent NR/NA rating) and there must be at least two therapeutically equivalent multiple-source drugs, or at least one generic from one manufacturer, available to network pharmacies from national/regional wholesalers.
  • Removal requirement: PBM/covered entity must remove a drug from MAC list within 3 business days if it no longer meets eligibility criteria.
  • Disclosure and access:
    • PBMs must provide contracted/network pharmacies (at contract start, renewal, or on request) the sources used to determine MACs, every MAC used for that pharmacy, and, upon request, every MAC list used for patients served by that pharmacy.
    • MAC lists must be made available in a readily accessible, secure, usable web-based format (or comparable).
  • Minimum MAC standards:
    • MAC (or ingredient cost if MAC not used) must be ≥ pharmacy acquisition cost. A MAC ≥ National Average Drug Acquisition Cost (NADAC) satisfies this requirement.
    • MAC for non‑affiliated pharmacies must be ≥ MAC for PBM-affiliated/owned pharmacies.
  • Update and payment timing:
    • PBMs must update each MAC list at least every 3 business days and use updated MACs to calculate payments within 2 business days.
  • Appeals process:
    • PBMs must establish a clear contest/appeal process. Pharmacies (or a Pharmacy Services Administrative Organization on their behalf) must file appeals within 7 business days of submitting the initial reimbursement claim.
    • PBM must issue a final determination within 7 business days of receiving the appeal.
    • If denied, PBM must give reasons and cite an NDC for an equivalent drug available at an equal or lower price.
    • If appeal is validated, PBM must retroactively adjust costs, reprocess claims effective from the appeal filing date and reimburse accordingly, and apply adjusted costs to similar pharmacies within 3 business days.

Who is affected

  • Pharmacy benefits managers and covered entities administering pharmacy benefits
  • Retail, independent, and network pharmacies (including non-affiliated pharmacies)
  • Pharmacy Services Administrative Organizations (PSAOs)
  • Wholesalers (as availability criteria reference national/regional wholesalers)
  • Health plans, insurers and ultimately patients (indirect effects on drug access/costs)

Procedural status (as provided)

  • Introduced: March 4, 2025; read twice and referred to Committee on Veterans’ Affairs (records also show referral to Health and Financial Services in some entries).
  • Hearings: listed hearings in April–May 2025; committee reported with an amendment in the nature of a substitute favorably on July 30, 2025.
  • Related: similar/previous-session bills cited (e.g., S.715 of 2023–24, S.1903, S.1217).

Potential impacts and considerations

  • Increases transparency and may reduce situations where pharmacies are reimbursed below acquisition cost.
  • Could raise administrative burden on PBMs (frequent updates, disclosure, faster payment recalculations).
  • May affect pricing negotiations, availability of products on MAC lists, and the relative economics for PBM-affiliated vs. independent pharmacies.
  • Enforcement and auditing mechanisms (not detailed) will determine efficacy.

If you want, I can produce a plain‑language one-page fact sheet, extract the timeline of amendments/hearings, or compare this bill to prior-session companion bills referenced.

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

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