BOSTON—State Senator Jason Lewis, House Minority Leader Bradley H. Jones Jr., and State Representative Richard Haggerty joined their colleagues in the Massachusetts Legislature to pass comprehensive reforms to lower the cost of prescription drugs at the pharmacy counter and improve oversight of the state’s pharmaceutical industry.
An Act relative to pharmaceutical access, costs, and transparency takes bold action to lower or eliminate out-of-pocket costs and ensure access to life-saving medications by requiring health insurers to offer price relief for prescription drugs used to treat diabetes, asthma, and certain heart conditions. This bill further brings down costs by ensuring that consumers are not charged a cost-sharing amount, such as a co-pay, if it would be cheaper for them to purchase the drug without using their insurance. Approximately 9% of Massachusetts residents have diagnosed diabetes; 6% of adults over 35 have heart disease; and more than 10% of residents live with asthma. This bill is particularly critical for residents of color, who disproportionately face chronic illnesses. Over 12% of Black residents live with diabetes and nearly 14% of Black adults live with asthma.
“Working to expand access to quality, affordable healthcare has always been one of my top priorities in the legislature,” said State Senator Jason Lewis. “I’m proud to support this critical legislation that makes life-saving drugs more affordable and accessible for patients, and holds pharmaceutical companies, insurers, and pharmacy benefit managers more accountable for their actions.”
“This legislation tackles the problem of high prescription drug prices head-on by capping and in some cases eliminating out of pocket costs for consumers to make certain medications more affordable, including insulin,” said House Minority Leader Bradley H. Jones Jr. “The bill also takes important steps to license and regulate pharmacy benefit managers who serve as intermediaries between health insurance companies, pharmacies, and drug manufacturers to manage prescription drug benefits. This is a win-win for consumers, and I am happy the House and Senate were able to reach agreement on this bill.”
“This important legislation will help patients across the Commonwealth that are struggling with chronic illnesses by reducing their prescription drug costs,” said State Representative Richard Haggerty. “Not only does the bill cap out-of-pocket costs for critical medications, saving patients thousands of dollars, it ensures there is transparency and oversight of the pharmaceutical industry. This bill continues Massachusetts’ efforts to increase access to quality affordable health care.”
Key provisions of this legislation include:
- Lowering consumer prescription drug costs for diabetes, asthma, and certain heart conditions by requiring insurers to eliminate cost-sharing requirements for one generic drug and to cap co-payments on one brand-name drug at $25 per 30-day supply.
- Increasing oversight of pharmacy benefit managers (PBMs) by authorizing the state Division of Insurance to license and regulate PBMs, which play a major role in determining how prescription drugs are tiered and priced on insurance plans.
- Establishing the Office for Pharmaceutical Policy and Analysis within the Health Policy Commission (HPC) to analyze trends and publish an annual report with recommendations for strategies to promote affordability, enhance medication access, and mitigate pharmaceutical spending growth.
- Requiring pharmaceutical manufacturers and PBMs to provide public testimony on the factors that influence drug costs and allowing these factors to be taken into account by the HPC to identify how to improve care and reduce costs for patients.
After final passage in both the House and Representatives and the Senate, Governor Maura Healey signed the bill into law on January 8, 2025.
