H 1224 – Massachusetts

Status: In Process
Year Introduced: 2021
Link: https://malegislature.gov/Bills/192/H1224

Relative to healthcare access and affordability for patients. Financial Services. Provides “estimated rebate” shall mean (1) negotiated price concessions including, but not limited to, base rebates and reasonable estimates of any price protection rebates and performance-based rebates that may accrue, directly or indirectly, to a carrier during the plan year from a pharmaceutical manufacturer, dispensing pharmacy, or other party to the transaction based on the amounts the carrier receives in the prior quarter or reasonably expects to receive in the current quarter; and (2) reasonable estimates of any fees and other administrative costs that are passed through to the carrier and serve to reduce the carrier’s prescription drug liabilities for the plan year based on the amounts the carrier received in the prior quarter or reasonably expects to receive in the current quarter. A carrier shall annually certify to the commissioner that, during the prior plan year, the carrier made available to the insured at least 80 percent of the estimated rebates received by such carrier by reducing the amount of cost sharing that it would otherwise charge at the point of sale except that the reduction amout shall not result in a credit at the point of sale. Neither the insured nor the carrier is responsible for any difference between the estimated rebate amount and the actual rebate amount the carrier receives provided that such estimates were calculated in good faith.

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