The House advanced key PBM provisions this week as part of a comprehensive health care reform package to address the cost and accessibility of primary care services in the Commonwealth. The legislation, HR 5618, includes two main PBM provisions targeting PBM rebate contracting practices and as well as PBM common ownership. The bill mandates that insurers and PBMs must pass along at least 80 percent of estimated drug rebates to consumers at the pharmacy point of sale. Additionally, it tightens regulatory oversight of vertically integrated PBM “affiliated entities” within the Division of Insurance, reinforcing NACDS-supported regulations that were adopted earlier this year. Moving forward, the House bill will go to conference negotiations where there will be an opportunity to add additional PBM reform measures to the final package. 

For more information, please contact NACDS’ Mike Sargent at 207-272-6435.

The Division of Insurance published final regulations related to the Licensing and Regulation of Pharmacy Benefit Managers – 211 CMR 157. The Division accepted the NACDS and Massachusetts Chain Pharmacy Council’s proposed amendment to require PBMs to disclose any common ownership interest with an insurance carrier. The release of the final regulation, which is effective March 13, aligns with ongoing work in the Massachusetts Legislature to consider additional PBM reform initiatives. 

For more information, please contact NACDS’ Mike Sargent at 207-272-6435.

As a reminder, pharmacy practice resources, regulations and other resources are available on the website. See below for new and updated information. 

Policy 2023-09: Action Level Environmental Monitoring Results – identification to the species level is required for any growth found in ISO-5 areas and ISO-7 buffer rooms, and any action level growth in any other ISO classified areas. 

Advisory: Environmental Monitoring – the edits align with the changes to Policy 2023-09: Action Level Environmental Monitoring Results. 

Also in Massachusetts, the Department of Public Health (DPH) issued Guidance on Recommended Reference Materials for Pediatric Immunization Schedules. Please review this information, share it with colleagues and take any action steps that may be appropriate to integrate the recommendations into your practice. DPH also shared Childhood Immunization Discussion Guides that are available from the American Academy of Pediatrics.

For more information, contact NACDS’ Leigh Knotts at 803-243-7207.

The Board of Pharmacy shared the following updates. As a reminder, pharmacy practice documents, regulations and other resources are available on the website.  

Policy 2020-15: Scope of Practice  

Updates to this policy define "handling" of medications and that it requires an individual pharmacy license as well as defining the "prescription area" and who may access it.  

New Pharmacy Labeling Requirement 

Pharmacies must now label Schedule VI medications prescribed for reproductive or gender-affirming care with the name and address of the healthcare practice instead of the individual prescriber upon request from the prescriber.  

For more information, contact NACDS’ Leigh Knotts at 803-243-7207.

The Board of Registration in Pharmacy held its regular meeting on November 6. The agenda included the following: 

• New pharmacy labeling requirement (Shield Law 2.0) 

• Pharmacy Advisory Committee meeting summary 

• Recommendation for automated non-sterile compounding devices 

MassHealth provided notice via All Provider Bulletin 412 to all providers using 340B drugs that it will stop paying for the high-cost drugs listed in this most recent bulletin, in addition to those outlined in All Provider Bulletin 390 and All Provider Bulletin 400. This follows M.G.L. c. 118E, § 13L, 130 CMR 405.000: Community Health Centers, 130 CMR 406.000: Pharmacy Services and 130 CMR 410.000: Outpatient Hospital Services.  

MassHealth will implement these changes no sooner than May 4, 2026, through a follow-up All Provider Bulletin. MassHealth is inviting comments about these changes no later than December 3. See All Provider Bulletin 412 for details. 

For more information, please contact NACDS’ Mike Sargent at 207-272-6435.

On October 9, the Board of Pharmacy updated two items below:

The Opioid Prescription Drug Fact Sheet that must be distributed when dispensing a Schedule II or III prescription has been updated to reflect statutory changes. Please also note the change to state law that requires an opioid antagonist (e.g., naloxone) to be offered whenever a Schedule II opioid is dispensed.

Policy 2023-09: Action Level Environmental Monitoring Results

The requirement for growth identification in all ISO 7 areas is now only required for ISO 7 buffer rooms. This is in addition to the current identification mandates for ISO 5 areas and any action level growth in any ISO classified areas. Compounding during remediation now also differentiates between ISO 7 buffer rooms and other ISO 7 areas.

For more information, please contact NACDS’ Mike Sargent at 207-272-6435.

The Board of Pharmacy shared a reminder that the Opioid Pain Medication Drug Fact Sheet that must be distributed when dispensing a Schedule II or III prescription has been updated to reflect statutory changes. Please also note the change to state law that requires an opioid antagonist (e.g., naloxone) to be offered whenever a Schedule II opioid is dispensed. 

For more information, please contact NACDS’ Mike Sargent at 207-272-6435.

The Department of Public Health has recently issued a standing order allowing for all qualified pharmacy personnel at Massachusetts pharmacies to dispense and administer COVID-19 vaccine in Massachusetts to all eligible persons.

For more information, please contact NACDS’ Mike Sargent at 207-272-6435.

In this month’s Pharmacy Facts, published by MassHealth, they provided an update to the vaccine administration fee.

In accordance with 101 CMR 317.03(5): Allowable Fee for Certain Eligible Providers, payment for services provided by pharmacies that utilize pharmacists, or other health care professionals certified in accordance with 105 CMR 700.00: Implementation of M.G.L. c. 94C, is 85% of the allowable fee set forth in 101 CMR 317.04: Maximum Allowable Fees – Medical Services.

Following the pricing methodology cited above, for pharmacies that utilize pharmacists, or other health care professionals certified in accordance with 105 CMR 700.00: Implementation of M.G.L. c. 94C, the administration fee for vaccines other than COVID-19 is $17.38. The administration fee for COVID-19 vaccines is $38.21. Starting August 22, these rates were reflected on all such claims.

For more information, please contact NACDS’ Mike Sargent at 207-272-6435.