DiDomenico celebrates new law boosting oversight of pharmaceutical industry, lowering costs and saving lives

Bill includes oversight reforms to improve affordability of and access to prescription drugs

Special to The Advocate

Last month Senator Sal DiDomenico and his colleagues in the Legislature enacted a bill mandating comprehensive reforms that will lower the cost of prescription drugs and improve oversight of the state’s pharmaceutical industry: S.3012, An Act relative to pharmaceutical access, costs and transparency. On January 9, 2025, Governor Maura Healey signed S.3012 into law as Chapter 342 of the Acts of 2024. Chapter 342 requires health insurers to cover life-saving medications for diabetes, asthma and certain heart conditions with no or limited out-of-pocket costs for patients.

The law takes bold action to lower out-of-pocket costs and ensure access to life-saving medications by offering immediate price relief for prescription drugs used to treat diabetes, asthma and certain heart conditions. For each condition, the bill requires insurers to eliminate cost-sharing requirements for one generic drug and to cap copayments on one brand-name drug at $25 per 30-day supply. The law further brings down consumer costs by ensuring that consumers are not charged a cost-sharing amount, such as a copay, if it would be cheaper for them to purchase the drug without using their insurance.

“People throughout my district and our state rely on prescription medication to live, which is why I am thrilled to have helped pass this law which will bring down costs and ensure individuals don’t have to decide between paying for food and rent and accessing lifesaving drugs,” said Senator DiDomenico. “I have long been a supporter of bringing down the costs of prescription drugs and I know this new law will save lives across our state. I want to thank Senate President Spilka, Senator Friedman, and all of the advocates who worked diligently to get this important piece of legislation passed before the previous legislative session came to an end.”

Approximately 9 percent of Massachusetts residents have diagnosed diabetes and 6.2 per cent of adults over 35 live with heart disease. In 2015, more than 10 per cent of residents lived with asthma. Black residents face each at a higher rate – over 12 percent live with diabetes and nearly 14 percent of Black adults live with asthma.

The bill drastically increases state oversight of pharmacy benefit managers (PBMs), which currently negotiate prescription drug prices with little oversight, making it unclear if they consistently act in the best interest of consumers. To do so, the legislation authorizes the Division of Insurance) to license and regulate PBMs. PBMs are also prohibited from making payments to pharmacy benefit consultants or brokers who work on behalf of health plan sponsors during a contracting or bidding process.

To create a more complete data-driven picture of drug costs in Massachusetts, the Center for Health Information and Analysis (CHIA) will collect a range of drug cost information from pharmaceutical manufacturers and PBMs. With the data, CHIA can offer a more complete examination of the drivers of health care costs in its annual health care cost report, allowing policymakers and consumers to better understand the role of pharmaceutical manufacturers and PBMs in the health care system.

In addition to CHIA’s cost analysis, pharmaceutical manufacturers and PBMs will be included in the Annual Health Care Cost Trends Hearing of the Health Policy Commission (HPC) for the first time. Participation in the hearings will require manufacturers and PBMs to provide public testimony on the factors that influence drug costs, allowing those factors to be considered as HPC identifies how to improve care and reduce costs for residents.

Further, the legislation establishes the Office for Pharmaceutical Policy and Analysis within HPC, which will be tasked with analyzing trends related to pharmaceutical access, affordability and spending in Massachusetts. The office will publish an annual report with recommendations for strategies to mitigate pharmaceutical spending growth, promote affordability and enhance pharmaceutical access.