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Lawmakers hear bills to expand access to specialty medications and allow non-network dispensing
Summary
Senate Bill 734 and House Bill 1322 were presented to the Joint Committee on Financial Services with supporters saying the measures would let qualified non‑network pharmacies dispense specialty medications and reduce treatment delays.
BOSTON — Lawmakers heard testimony supporting legislation to ease access to specialty medications by expanding the number of pharmacies that may dispense them and by reducing PBM-imposed administrative barriers.
Senator Jamie Eldridge testified in support of Senate Bill 734, "an act ensuring access to specialty medications," which he said would define specialty drugs as those requiring special handling, administration or monitoring and would bar insurers from preventing non-network pharmacies that can meet those requirements from dispensing them. "PBMs and insurance companies are creating these barriers that make it harder for a lot of independent pharmacies to be able to deliver specialty drugs to their consumers," Eldridge said.
Representative Clayton Ruley filed similar legislation in the House (H.1322). Ruley told the committee that specialty medications are often high-cost and administratively burdensome for patients and providers; the proposed bills would create a procedure that allows qualifying independent pharmacies to dispense specialty drugs and thereby expand local access and support small pharmacies.
Supporters argued the bills would reduce delays in starting treatment, lower out-of-pocket costs caused by forced mail-order fills or vertical steering to PBM-owned specialty pharmacies, and help small independent pharmacies remain viable in their communities.
PBM testimony cautioned lawmakers about requirements that would limit plan sponsors' ability to design benefits and control cost: Sam Hallmeier of PCMA emphasized that plan sponsors choose PBMs for purchasing leverage and urged waiting for the Health Policy Commission's ongoing assessment rather than mandating network rules that could increase premiums or co-pays.
The committee did not vote on the measures. Sponsors asked for favorable reports and additional committee review of clinical credentialing, accreditation standards for specialty pharmacies, and fiscal modeling of any mandate.
Ending: The committee requested follow-up information on accreditation standards for specialty pharmacies and on the fiscal effects of limiting plan design options.
