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.

Prohibits payers, manufacturers, and distributors from discriminating against 340B entities and contract pharmacies, protecting patient choice and access to 340B drugs.

Massachusetts bill blocks nonmedical switching by health plans for patients stable on a drug, guarantees continuous coverage, and streamlines medical exemption decisions.