Massachusetts lawmakers push pharmacy benefit manager reforms to enhance medication access

The Massachusetts Joint Committee on Financial Services convened on June 10, 2025, to address the pressing issue of healthcare costs, particularly focusing on the impact of pharmacy benefit managers (PBMs) on patients with chronic illnesses. A significant highlight of the meeting was the urgent call for reform to ensure that patients receive the full benefits of negotiated drug rebates, which are currently retained by PBMs, inflating out-of-pocket costs for essential medications.

Testimonies from various advocates underscored the dire financial burden faced by individuals managing chronic conditions like diabetes. One speaker revealed that the annual medical costs for a person with diabetes-related kidney failure in Massachusetts can reach $160,000, emphasizing that without reform, many patients are forced to ration their medications, risking their health and well-being. The discussion highlighted the need for transparency in drug pricing and the importance of passing rebates directly to patients at the pharmacy counter.

Marissa Shackleton, executive director of the Elliot Lewis Center, passionately advocated for bills aimed at reforming PBM practices, stating that healthcare decisions should be made between patients and their providers, not dictated by profit-driven middlemen. She pointed out that the current system often leads to unnecessary delays in treatment, resulting in avoidable hospitalizations and increased healthcare costs.

Joanne Doyle Catrangelo, representing the Massachusetts Pharmacists Association, shared alarming examples of how PBM practices complicate patient care, including lengthy prior authorization processes that can lead to critical delays in medication access. She urged the committee to support legislation that would improve reimbursement for community pharmacies, which are struggling to remain viable under the current system.

The meeting also featured personal accounts from individuals living with diabetes, who described the emotional and financial toll of managing their conditions amidst rising medication costs. One speaker poignantly noted that their out-of-pocket expenses for diabetes management could have funded their child's college education, highlighting the stark reality many families face.

As the committee deliberates on these critical reforms, the testimonies reflect a growing consensus that immediate action is necessary to restore fairness and transparency in the healthcare system, ensuring that patients can access the medications they need without crippling financial strain. The anticipated outcomes of these discussions could reshape the landscape of healthcare affordability in Massachusetts, potentially setting a precedent for similar reforms nationwide.