Mass. Gen. Laws ch. 12C, sec. 10A — MA Code / Part I / Title II / Chapter 12C / Section 10A
Reporting requirements for pharmacy benefit managers
Status: in_force

Section 10A. (a) The center shall promulgate regulations necessary to ensure the uniform reporting of information from pharmacy benefit managers to enable the center to analyze: (i) year-over-year changes in wholesale acquisition cost; (ii) year-over-year trends in formulary, maximum allowable cost lists and cost-sharing design, including the establishment and management of specialty product lists; (iii) aggregate information regarding discounts, utilization limits, rebates, administrative fees charged to pharmaceutical manufacturing companies and other financial incentives or concessions related to pharmaceutical products or formulary programs; (iv) trends in estimated aggregate drug rebates and other aggregate drug price reductions, if any, provided by a pharmacy benefit manager to a carrier client or health plan sponsor or passed through from a pharmacy benefit manager to a carrier client or health plan sponsor in connection with utilization of drugs in the commonwealth offered through the pharmacy benefit manager and a measure of lives covered by each carrier client or health plan sponsor in the commonwealth; and (v) any other information deemed reasonably necessary by the center by regulation. (b) The center shall require the submission of available data and other information from pharmacy benefit managers including, but not limited to: (i) the aggregate amount of all rebates that the pharmacy benefit manager received from all pharmaceutical manufacturing companies and for all carrier clients or health plan sponsors; (ii) the administrative fees that the pharmacy benefit manager received from all carrier clients or health plan sponsors in the aggregate and for each carrier client or health plan sponsor individually; (iii) the aggregate amount of rebates a pharmacy benefit manager: (A) retains based on its contractual arrangement with each carrier client or health plan sponsor individually; and (B) passes through to each carrier client or health plan sponsor individually; (iv) the aggregate amount of all retained rebates that the pharmacy benefit manager received from all pharmaceutical manufacturing companies and did not pass through to each pharmacy benefit manager's carrier client or health plan sponsor individually; (v) the percentage of contracts that a pharmacy benefit manager holds where the pharmacy benefit manager: (A) retains all rebates; (B) passes all rebates through to the carrier client or health plan sponsor; and (C) shares rebates with the carrier client or health plan sponsor; and (vi) information related to the pharmacy benefit manager practices of spread pricing, administrative fees, claw backs and formulary placement. (c) Except as specifically provided otherwise under this chapter, data collected by the center pursuant to this section shall not be a public record under clause Twenty-sixth of section 7 of chapter 4 and section 10 of chapter 66. No such data shall be disclosed in a manner that is likely to compromise the financial, competitive or proprietary nature of such data and other information, or that may identify specific prices charged for drugs, the value of any rebate amounts, individual drugs, or any pharmaceutical manufacturing company.

Section 10A. (a) The center shall promulgate regulations necessary to ensure the uniform reporting of information from pharmacy benefit managers to enable the center to analyze: (i) year-over-year changes in wholesale acquisition cost; (ii) year-over-year trends in formulary, maximum allowable cost lists and cost-sharing design, including the establishment and management of specialty product lists; (iii) aggregate information regarding discounts, utilization limits, rebates, administrative fees charged to pharmaceutical manufacturing companies and other financial incentives or concessions related to pharmaceutical products or formulary programs; (iv) trends in estimated aggregate drug rebates and other aggregate drug price reductions, if any, provided by a pharmacy benefit manager to a carrier client or health plan sponsor or passed through from a pharmacy benefit manager to a carrier client or health plan sponsor in connection with utilization of drugs in the commonwealth offered through the pharmacy benefit manager and a measure of lives covered by each carrier client or health plan sponsor in the commonwealth; and (v) any other information deemed reasonably necessary by the center by regulation.

(b) The center shall require the submission of available data and other information from pharmacy benefit managers including, but not limited to: (i) the aggregate amount of all rebates that the pharmacy benefit manager received from all pharmaceutical manufacturing companies and for all carrier clients or health plan sponsors; (ii) the administrative fees that the pharmacy benefit manager received from all carrier clients or health plan sponsors in the aggregate and for each carrier client or health plan sponsor individually; (iii) the aggregate amount of rebates a pharmacy benefit manager: (A) retains based on its contractual arrangement with each carrier client or health plan sponsor individually; and (B) passes through to each carrier client or health plan sponsor individually; (iv) the aggregate amount of all retained rebates that the pharmacy benefit manager received from all pharmaceutical manufacturing companies and did not pass through to each pharmacy benefit manager's carrier client or health plan sponsor individually; (v) the percentage of contracts that a pharmacy benefit manager holds where the pharmacy benefit manager: (A) retains all rebates; (B) passes all rebates through to the carrier client or health plan sponsor; and (C) shares rebates with the carrier client or health plan sponsor; and (vi) information related to the pharmacy benefit manager practices of spread pricing, administrative fees, claw backs and formulary placement.

(c) Except as specifically provided otherwise under this chapter, data collected by the center pursuant to this section shall not be a public record under clause Twenty-sixth of section 7 of chapter 4 and section 10 of chapter 66. No such data shall be disclosed in a manner that is likely to compromise the financial, competitive or proprietary nature of such data and other information, or that may identify specific prices charged for drugs, the value of any rebate amounts, individual drugs, or any pharmaceutical manufacturing company.