February 11, 2025
On Jan. 9, Gov. Maura Healey (D) signed two health care bills, S.3012 and H.5159, into law. The bills were resuscitated at the end of the year when amended versions were passed by the legislature. The Senate bill includes new oversight and transparency requirements applicable to PBMs and pharmaceutical manufacturers, establishes new coverage requirements and creates narrow exemptions for member cost-sharing, among other provisions.
As a result of State Government Affairs (SGA) advocacy and industry engagement, several harmful provisions were removed, including provisions limiting the use of prior authorizations; a point-of-sale rebate requirement; any willing provider requirements for home delivery, specialty, and preferred networks; and a prohibition on copay accumulator programs.
The House legislation expands the scope of the Health Policy Commission (HPC) cost trends hearings to include an examination of pharmaceutical manufacturing companies and PBMs and expands HPC’s examination authority to include new data collected by the state from PBMs.
It also expands HPC oversight over for-profit investments in health care by broadening the types of transactions and entities that must file a notice of material change with the HPC while providing more authority to the Attorney General to review private equity transactions.
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