A bill that would cap out-of-pocket costs on certain prescription drugs treating diabetes, asthma and heart conditions is set for a vote Wednesday in the Massachusetts House.
The new bill is one of several major health care reforms currently in play on Beacon Hill. It would also add new licensure requirements and regulations for pharmacy benefit managers — known as PBMs, the third parties that help determine drug prices and play an intermediary role between pharmaceutical companies, health insurers and pharmacies.
“Many folks in Massachusetts face cost barriers in access to the medications they are prescribed, especially for many of our most vulnerable residents who live with chronic disease,” House Speaker Ron Mariano, a Quincy Democrat, said in a statement. “This bill aims to reduce the out-of-pocket cost of certain lifesaving drugs and ban certain business practices that are commonly used by PBMs to increase their own profits at the expense of patients.”
Lawmakers pitched it as a bid for health equity to address chronic conditions that disproportionately impact people of color.
Under the bill, insurers would be required to identify one generic medication and one brand-name drug used to treat each of three chronic conditions: diabetes, asthma and the most prevalent heart condition among people enrolled in their plans. They would need to cover the generic drug without any patient costs, and for the brand-name drug, the patient’s copay would be capped at $25 for a 30-day supply.
The Senate passed its own prescription drug bill last fall, which proposes a similar drug-cost cap and also would impose added oversight on PBMs, though the policy specifics differ.
The Senate’s unanimous vote in November 2023 marked the third time since 2019 that senators have passed legislation targeting pharmaceutical costs. This is the first time the House has answered with a bill of its own, boosting the odds of a final version landing on Gov. Maura Healey’s desk by the time formal legislative sessions end for the year on July 31.
The Patients Not PBMs coalition, which has been advocating on Beacon Hill for more state oversight of pharmacy benefit managers, said in a statement to GBH News that the House’s move “puts Massachusetts on the doorstep of being first again in passing much needed reforms that will protect patients and pharmacists.”
The Senate and House often have different priorities when it comes to health care reforms, but with a handful of significant health policy proposals on the move, the two branches will have plenty of opportunities to strike a deal, if little time left to do so.
Inspired by the financial crisis at Steward Health Care and the uncertain future of the company’s Massachusetts hospitals, the House and Senate have each now passed different bills that would strengthen the state’s hospital oversight mechanisms. The Senate’s version of that bill also incorporates some PBM reforms.
The House has also passed a bill aimed at improving pregnancy and postpartum care, and another focused on long-term care facilities. The Senate has its own version of the long-term care bill teed up for debate on Thursday.
