Mass. General Laws c.94C § 21C

Pharmacy prescription drug charges at point of sale must not exceed retail price

This is an unofficial version of a Massachusetts General Law.

Updates

Added by St. 2024, c. 342, § 27, effective April 8, 2025

Section 21C

(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.

Last updated:	January 8, 2025