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S 830

Requires parole violators to be transferred to state correctional facilities after 10 days in a local correctional facility

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

The bill requires transparent, fair pharmacy payments by PBMs, eliminates retroactive discounts, standardizes MAC rules, and creates clear pharmacy appeals to preserve local commun

REFERRED TO CRIME VICTIMS, CRIME AND CORRECTION
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Bill Summary · S 830

Summary — S.830 (Senate Docket No. 1262): "An Act to preserve community pharmacies"

Note on sources: The bill text submitted is a Massachusetts Senate bill (presented by Sen. Bruce E. Tarr) titled "An Act to preserve community pharmacies." Some metadata supplied with the request (different sponsor names, an unrelated short title about parole violators, and varied committee referrals) appears inconsistent with the bill text. This summary reflects the language and substance of the Massachusetts bill as filed (Senate Docket No. 1262 / S.830).

Purpose / Intent

To strengthen and preserve community (retail/independent) pharmacies by increasing payment transparency and fairness from Pharmacy Benefit Managers (PBMs) and other payors, restricting certain retroactive payment practices, standardizing maximum allowable cost (MAC) rules, and establishing pharmacy audit and appeal processes.

Key provisions and changes

  • Definitions: Establishes statutory definitions for "brand name drug," "generic drug," "Pharmacy Audit," and "Pharmacy Benefit Manager" (referencing M.G.L. c.175 §226(a)).
  • Payment terms (Section 1):
    • Requires pharmacy service contracts between PBMs and pharmacies to include:
    • An ingredient cost that meets criteria in Section 2.
    • A dispensing fee equal to that paid by the Massachusetts Medicaid program.
    • Clean claim payments must include all applicable discounts.
    • Prohibits contracts that impose retroactive discounts using constructs such as "Generic Effective Rate," "Brand Effective Rate," or similar retroactive rate reductions.
  • Ingredient cost / MAC rules (Section 2):
    • Defines "maximum allowable cost list" (MAC list) and "maximum allowable cost" (MAC).
    • If a MAC or ingredient cost is used, it must be equal to or greater than the cost used by the Massachusetts Medicaid program.
    • MACs for non‑affiliated pharmacies must be equal to or greater than those for pharmacies affiliated with/owned by the PBM.
    • A drug cannot be placed on a MAC list unless:
    • It is rated A/AB in the FDA Orange Book (or has equivalent NR/NA rating in another recognized reference), and
    • There are at least two therapeutically equivalent, multiple‑source drugs, or at least one generic from a manufacturer, available to network pharmacies from registered national/regional wholesalers.
    • PBMs/covered entities must:
    • Provide pharmacies, at contract start/renewal or upon request, the sources used to set MACs, every MAC used for that pharmacy, and, upon request, every MAC list used for that pharmacy’s patients.
    • Update each MAC list at least every 3 business days and make updated lists available in a secure, accessible web‑based (or comparable) format.
    • Use updated MACs to calculate payments to contracted pharmacies within 2 business days.
  • Appeals and contestation:
    • PBMs must establish a clear process through which a pharmacy may contest a cost.
    • Grounds for appeal include ingredient cost below Massachusetts Medicaid levels or placement on a MAC list that does not meet statutory requirements.
    • A pharmacy must file its appeal within seven business days of submitting the initial claim. Pharmacy Services Administrative Organizations (PSAOs) may appeal on behalf of pharmacies.
    • (The posted text truncates during the description of the PBM's obligation to resolve appeals; the bill likely sets a timeframe for final determinations but that portion is incomplete in the available text.)

Who is affected

  • Independent and community retail pharmacies (primary beneficiaries).
  • Pharmacy Benefit Managers (PBMs) and covered entities (subject to new transparency, update frequency, payment parity, and appeal process requirements).
  • Pharmacies affiliated with/owned by PBMs (treated comparably in MAC setting).
  • Pharmacy Services Administrative Organizations (PSAOs) (authorized to appeal).
  • Patients and health plans indirectly (potential effects on access to local pharmacies, reimbursement flows, and drug pricing dynamics).
  • Massachusetts Medicaid program is used as a pricing/payment benchmark.

Likely impacts

  • Increased transparency of MACs and pricing sources; reduced use of retroactive discounts/clawbacks.
  • Potential improvement in reimbursement predictability for community pharmacies, which could help financial viability and local access.
  • Operational/administrative burden on PBMs to update MAC lists rapidly, publish sources, and manage appeals.
  • Potential market effects if MAC floors tied to Medicaid raise reimbursement levels for certain generics/brands.

Procedural status (as provided)

  • Filed / presented as Senate Docket No. 1262 (filed 1/16/2025); presented by Sen. Bruce E. Tarr (petition signature includes Peter J. Durant).
  • Introduced / read twice (March 4, 2025) and referred to committees (materials contain various committee names — Financial Services and Health‑related committees are cited). A hearing was scheduled for 06/10/2025 (per supplied actions).
  • Note: Metadata supplied with the request included other sponsor names and unrelated referral notes; those appear inconsistent with this Massachusetts bill text.

Limitations / missing information

  • The provided bill text is truncated during the appeals section; the full text may include additional timelines, enforcement mechanisms, penalty provisions, or administrative instructions not visible here.
  • Some supplied metadata appears to mix bills or jurisdictions; users should consult the official legislative clerk or bill page for authoritative procedural status and the complete bill text.

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

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