Bill
H 4494
Mass. H.4494 bars PBMs from discriminating against 340B entities; prohibits lower reimbursement, extra fees, network limits, or steering; protects safety-net providers and patients.
Below are two distinct measures that appear together in the provided packet but are different in scope, jurisdiction, and status. I summarize each separately so readers can quickly understand purpose, key provisions, affected parties, and procedural status.
Summary
- Purpose: To prohibit pharmacy benefit managers (PBMs) and other third parties that reimburse 340B covered entities from engaging in contracting, reimbursement, network, billing, or steering practices that penalize or identify participation in the federal 340B drug discount program.
- Statutory placement: Adds Section 31 to Chapter 176O of the Massachusetts General Laws (Chapter governing PBMs).
Key provisions (text-paraphrase)
- Defines “340B covered entity” to include entities participating in 42 U.S.C. §256b (the federal 340B program), their pharmacies, and contracted pharmacies that dispense 340B-purchased drugs.
- Prohibits any PBM or third party that reimburses a 340B covered entity from:
1. Reimbursing a 340B covered entity at a lower rate than non-340B entities for the same drug.
2. Assessing fees, charge-backs, or other adjustments because an entity participates in the 340B program.
3. Restricting participation in a pharmacy or provider network on the basis of 340B status.
4. Requiring a 340B covered entity to contract with a specific pharmacy to join the PBM/third party’s network.
5. Requiring claims to be flagged/modified to identify 340B drugs (except when claims are paid, directly or indirectly, by Medicaid).
6. Imposing coverage/benefit limits or extra patient charges (higher copays, coinsurance, second copays, penalties) when drugs are obtained from a 340B covered entity.
7. Interfering with a patient’s choice to obtain drugs from a 340B covered entity through inducements, steering, or incentives.
Who is affected
- Primary: PBMs and other third-party payers that reimburse providers/ pharmacies; 340B covered entities (safety-net hospitals, community health centers, and affiliated pharmacies); contracted pharmacies dispensing 340B drugs.
- Secondary: Patients/enrollees (preserves ability to obtain drugs from 340B providers without additional costs); insurers/employers may be indirectly affected by contracting and reimbursement changes.
- Medicaid carve-out: The text allows identification/modifiers for 340B drugs if the claim is for payment by Medicaid (consistent with federal Medicaid requirements).
Potential impact
- Seeks to protect 340B program participants from discriminatory reimbursement and contracting practices that could undermine the financial viability of safety-net providers.
- Could limit PBM practices such as differential reimbursement, forced steering to particular pharmacies, or billing modifiers for program-tracking outside Medicaid.
- May lead to changes in PBM-provider contracts and network participation rules in Massachusetts; fiscal effects depend on market responses and whether payers alter rates or exclude some arrangements.
- Enforcement mechanism is not specified in the excerpt (would rely on Chapter 176O enforcement provisions—typically the Division of Insurance/attorney general/regulatory authority).
Procedural / timeline status (from packet)
- Filed: 9/8/2025 (document indicates committee activity around Sept 18, 2025).
- 2025-09-18: Reported from the Committee on Financial Services; committee recommended the accompanying bill ought to pass and the new draft of H1274 was reported; referred to Committee on Health Care Financing.
Summary
- Purpose: A ceremonial House resolution honoring Amy Cooper as the 2025–2026 Teacher of the Year for Lexington Technology Center, expressing gratitude for her service and wishing her continued success.
- Nature: Non-binding, honorary resolution (ceremonial recognition).
Key content
- Recognizes Amy Cooper’s selection as Lexington Technology Center’s Teacher of the Year for 2025–2026.
- Notes her educational background: B.A. in Parks, Recreation, and Tourism (Clemson University) and M.A. in Teaching Students with Learning Disabilities (Francis Marion University).
- Highlights nearly 25 years of classroom experience, leadership, mentorship, and contributions to students.
- Directs that a copy of the resolution be presented to Amy Cooper.
Who is affected
- Primary: Amy Cooper and the Lexington Technology Center community (students, colleagues).
- Secondary: Symbolic recognition for educators; no regulatory or fiscal impacts.
Procedural / timeline status (from packet)
- Introduced and adopted by the South Carolina House of Representatives on May 6, 2025.
- Sponsors: Large list of House members (document lists many co-sponsors).
- Effect: Ceremonial; presented to the honoree.
If you want, I can:
- Produce a one-page brief focused solely on the Massachusetts 340B bill with implications for hospitals and PBMs (legal/enforcement options and likely industry responses).
- Draft suggested talking points or a short press summary for the South Carolina resolution.
Compiled from official sources — confirm details with the bill’s official record.
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