Requires adding mufflers to MA vehicle inspections; RMV to set rules, issue rejection stickers, and fines for non-compliant mufflers, affecting owners, shops, and enforcement.

Requires a separate prescription drug out-of-pocket limit in MA health plans, capped at the HDHP minimum annual deductible, protecting patients from high drug costs starting 2026.

Authorizes Arlington to use ranked-choice voting for specified local offices, pending voter approval; uses round-by-round tallies and publishes results to boost transparency.

Moves to curb PBMs in Massachusetts to expand pharmacy access by ensuring payment parity, banning steering and retroactive discounts, and mandating MAC transparency and updates.