Massachusetts lawmakers are set to vote on a transformative bill that could eliminate out-of-pocket costs for certain essential medications used to treat asthma, diabetes, and heart conditions. Scheduled for discussion on Wednesday in the Massachusetts House, the bill represents a significant push towards reducing medication costs and enhancing health equity.
The proposed legislation, part of a broader suite of health care reforms under consideration on Beacon Hill, aims to address financial barriers faced by residents, particularly those managing chronic conditions. House Speaker Ron Mariano, a Quincy Democrat, emphasized the bill’s importance, stating, “Many residents struggle with the cost of medications, particularly those with chronic diseases. This bill seeks to alleviate these burdens by capping patient costs and curbing exploitative practices by pharmacy benefit managers (PBMs).”
The bill outlines that insurers would be obligated to provide coverage for one generic and one brand-name drug per chronic condition—diabetes, asthma, and the most common heart condition covered by their plans. For the generic medication, patients would incur no costs, while the brand-name drug’s copay would be capped at $25 for a 30-day supply.
Additionally, the bill proposes new licensure requirements and regulatory measures for PBMs, the intermediaries responsible for negotiating drug prices between pharmaceutical companies, health insurers, and pharmacies. These reforms are intended to address concerns that PBMs’ practices may drive up costs and undermine patient access to necessary medications.
This legislative effort follows a similar proposal passed by the Senate last fall, which also aims to cap drug costs and enhance oversight of PBMs. The Senate’s unanimous approval of its bill in November 2023 marked the third attempt since 2019 to tackle pharmaceutical costs through legislation. This marks the first time the House has proposed a competing bill, increasing the likelihood that a final version will reach Governor Maura Healey before the legislative session concludes on July 31.
The Patients Not PBMs coalition, which has been advocating for increased state regulation of PBMs, welcomed the House’s proposal. “This bill positions Massachusetts to lead the nation in enacting critical reforms that protect patients and support pharmacists,” the coalition stated in a release to GBH News.
Both the Senate and House are pursuing various health policy reforms, including measures to improve hospital oversight and long-term care facilities, inspired by recent financial instability at Steward Health Care and other state health concerns. The Senate is also set to debate a long-term care bill later this week, mirroring the House’s focus on improving care standards.
As the legislative session draws to a close, the convergence of these health reform proposals suggests a robust dialogue between the two branches, with potential for comprehensive legislative action by the end of July.
