Massachusetts H1247 regulates pharmacy benefit managers' reimbursements to pharmacies, ensuring fair compensation and appeal processes.

Massachusetts H1247 amends Chapter 176D of the General Laws to establish guidelines for pharmacy benefit managers' reimbursements to pharmacies. The bill mandates that pharmacy benefit managers provide timely updates to their maximum allowable cost lists and ensure pharmacies receive prompt notifications of these updates. It also requires a reasonable administrative appeal procedure for pharmacies to challenge reimbursements. If a challenge is upheld, the pharmacy benefit manager must adjust the maximum allowable cost and permit the pharmacy to rebill.

Massachusetts H1247 regulates pharmacy benefit managers' reimbursements to pharmacies, ensuring fair compensation and appeal processes.

Massachusetts H1247 amends Chapter 176D of the General Laws to establish guidelines for pharmacy benefit managers' reimbursements to pharmacies. The bill mandates that pharmacy benefit managers provide timely updates to their maximum allowable cost lists and ensure pharmacies receive prompt notifications of these updates. It also requires a reasonable administrative appeal procedure for pharmacies to challenge reimbursements. If a challenge is upheld, the pharmacy benefit manager must adjust the maximum allowable cost and permit the pharmacy to rebill.