A recent compromise bill S 3012 aimed at lowering the cost of medications for chronic illnesses has been sent to Massachusetts Governor Maura Healey for approval.
The bill would cap the cost of certain name-brand medications, such as insulin, to $25 and eliminate out-of-pocket costs for comparable generic drugs for patients with chronic conditions like diabetes, asthma, and heart disease.
Additionally, it mandates insurance coverage for one generic and one name-brand drug for each of these conditions.
The bill also addresses concerns about the influence of pharmacy benefit managers PBMs, who mediate between insurers, pharmacies, and manufacturers. The new legislation would regulate PBMs, requiring them to be licensed and overseen by the Division of Insurance, as well as prohibiting conflict-of-interest payments to consultants.
A major focus of the bill is increasing transparency in the role PBMs play in driving up drug prices, with provisions to collect data and issue regulations on their practices.
While the bill represents a significant step in improving access and affordability for medications, it has excluded provisions related to delivery mechanisms like needles and inhalers, and protections for independent pharmacists.
Nevertheless, the bill is set to take effect in July 2025, with full implementation of PBM regulations starting in 2026.
Supporters of the bill, including patient advocacy groups, have hailed it as a victory for consumers, particularly by addressing the rising costs of prescription drugs and ensuring that patients are not burdened by excessive co-pays or deductibles.
The bill also includes provisions to create an Office for Pharmaceutical Policy and Analysis to monitor drug costs and analyze trends.
Governor Healey now faces the decision of whether to sign the bill or let it expire by not acting within the remaining hours of the legislative term.