Jan 07, 2025
BOSTON, Mass. (SHNS)--Legislation Governor Maura Healey plans to sign Wednesday will cap out-of-pocket costs for certain name-brand medications used to treat chronic conditions at no more than $25, and will make similar generic drugs entirely free for patients. Healey plans to host a ceremony at 11 a.m. Wednesday with legislative leaders to sign both the prescription drug bill and a hospital oversight bill partly inspired by the Steward Health Care collapse. The prescription drug bill aims to reduce the financial burden on individuals with common chronic illnesses. Healey will sign health care oversight bill Under the bill, insurers will be required to fully cover the cost of one generic drug, eliminating co-pays, co-insurance, and deductibles for patients for each of the following: diabetes, asthma, and the two most prevalent heart conditions. For selected name-brand medications, co-pays will be capped at $25, and these drugs will be exempt from deductibles or co-insurance. The measure also takes aim at growing scrutiny of pharmacy benefit managers, entities that mediate transactions between drug manufacturers, pharmacies, and insurers. While PBMs argue that their role helps lower costs, critics contend that a lack of oversight over the agencies has contributed to rising drug prices. The Division of Insurance will be responsible for licensing and regulating their operations in Massachusetts under the law. The new law will also prohibits PBMs from making payments to pharmacy benefit consultants or brokers if there is a conflict of interest. Additionally, the Center for Health Information and Analysis will be tasked with collecting data on PBMs and studying the factors driving prescription drug cost increases. A new Office for Pharmaceutical Policy and Analysis will be created within the Health Policy Commission to monitor pharmaceutical trends, including access, affordability, and spending. The HPC will also be authorized to review pharmaceutical manufacturers and PBMs. The bill also attempts to ensure patients purchasing prescription drugs at a pharmacy are not charged more via cost-sharing, by using a co-pay or deductible, if it's cheaper for them to buy it directly, according to Sen. Cindy Friedman, who co-chaired the negotiating committee on the bill with Rep. John Lawn.
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