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The PACT Act also establishes an Office for Pharmaceutical Policy and Analysis (OPPA) within the Health Policy Commission, according to Rep Marcus Vaughn (R-Wrentham).
Patients would pay no more than $25 for certain name-brand medications to treat chronic illnesses, including insulin for diabetes, and face no costs whatsoever for similar generic options under a compromise bill that the House and Senate whisked to Gov. Maura Healey's desk on Monday.
The bill (S 3012) that popped out of months of private talks late Friday would also add scrutiny to pharmacy benefit managers, and eliminate or cap out-of-pocket costs for drugs that treat certain chronic conditions.
The branches sent the bill to Healey with just one day remaining in the two-year term, leaving only hours to iron out any potential differences and likely giving Healey just two options - sign it or let it die by pocket veto.
State Representative Marcus Vaughn (R-Wrentham) is hailing the passage of the legislation, also known as the PACT Act, which represents a compromise agreement negotiated by a six-member conference committee that worked to resolve the differences between prior versions of the bill passed in both legislative branches.
Representative Vaughn, who supported the original House version of the bill that was engrossed on a vote of158-0 on July 24, said the PACT Act will help consumers by making certain prescription drugs more affordable, including insulin. He noted that the bill requires health insurers offering individual or group health maintenance policies in Massachusetts, including MassHealth, to limit out-of-pocket costs for medications used to treat diabetes, asthma, and the two most prevalent heart conditions among their members, with insurers required to select one generic and one brand name drug to be subject to a co-pay cap.
Under the PACT Act, generic drugs selected by insurers must be provided to members free of charge and will not be subject to any co-payments, co-insurance, or deductible. For brand name drugs selected by insurers, co-pays will be capped at $25 for a 30-day supply. Representative Vaughn said the bill preserves the original House bill’s provision ensuring a continuity of coverage policy for new members who have been previously prescribed and are stable on a drug that has not been selected by the insurer.
According to Representative Vaughn, the PACT Act also establishes a formal licensing process for pharmacy benefit managers (PBMs), who act as intermediaries between health insurance companies, pharmacies, and drug manufacturers to manage prescription drug benefits. The bill authorizes DOI to license and regulate PBMs operating in Massachusetts, with licenses valid for 3 years and renewals subject to the same time limits.
In addition to conducting examinations to ensure that a pharmacy benefit manager can meet its responsibilities under contracts with carriers, DOI will also be empowered to suspend, revoke, or renew a license with restrictions if such action is deemed necessary to protect the best interest of consumers. According to Vaughn, the bill sets a fee of $25,000 for applying for or renewing a license.
Representative Vaughn said the PACT Act also establishes an Office for Pharmaceutical Policy and Analysis (OPPA) within the Health Policy Commission (HPC). The OPPA will be primarily responsible for analyzing trends related to the access and affordability of pharmaceutical drugs in the Commonwealth and will advise the state in matters relating to pharmaceutical drug policy.
