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.
Contact
Online
Last updated: | January 8, 2025 |
---|