Mass. Gen. Laws ch. 94C § 21C

Current through Chapter 373 of the 2024 Legislative Session, with the exception of Acts not available as of 1/14/2025

Section 94C:21C - [Effective 4/8/2025] Charges for prescription drugs at point of sale

(a) For the purposes of this section, the following words shall have the following meanings unless the context clearly requires otherwise:

"Cost-sharing", an amount owed by an individual under the terms of the individual's health benefit plan.

"Health benefit plan", as defined in section 1 of chapter 176O.

"Pharmacy benefit manager", as defined in section 1 of chapter 176Y.

"Pharmacy retail price", the amount an individual would pay for a prescription drug at a pharmacy if the individual purchased that prescription drug at that pharmacy without using a health benefit plan or any other prescription medication benefit or discount.

(b) At the point of sale, a pharmacy shall charge an individual for a prescription drug the lesser of:

(i) the applicable cost-sharing amount; or

(ii) the pharmacy retail price.

(c) A health benefit plan or carrier shall not require an insured to make a cost-sharing payment for a prescription drug in an amount greater than that charged pursuant to subsection (b).

(d) No contractual obligation between a pharmacy benefit manager and a pharmacist shall prohibit a pharmacist from complying with this section.

Mass. Gen. Laws ch. 94C, § 94C:21C

Added by Acts 2024, c. 342,§ 27, eff. 4/8/2025.