Pharmacists for Fair Reimbursement What your state's PBM laws actually mean for community pharmacies
State Tracker Updated June 15, 2026

Massachusetts: what the PBM reimbursement law requires

Massachusetts licenses and regulates PBMs, requires MAC pricing updates at least every 7 days with a MAC appeal, mandates cost reporting, and caps consumer cost-sharing — but it does not set a reimbursement floor and does not ban spread pricing.

Status Partially enacted
Law Chapter 342 of the Acts of 2024 — M.G.L. c. 176Y
Effective date PBM licensure required by January 1, 2026
Reimbursement basis No reimbursement floor. Massachusetts licenses PBMs, requires MAC pricing updates at least every 7 days with a MAC appeals process, mandates cost and pricing reporting, and caps consumer cost-sharing on certain drugs. Spread pricing is disclosed but not banned.
Professional dispensing fee Not specified in statute
Appeal route Pharmacy files within 7 business days of the initial claim; the PBM makes a final determination within 7 business days

Massachusetts now licenses and regulates PBMs under M.G.L. c. 176Y (created by Chapter 342 of the Acts of 2024), with licensure required by January 1, 2026. PBMs must keep MAC pricing current — updated at least every 7 days — offer a MAC appeal, report cost and pricing data, and observe consumer cost-sharing caps on certain drugs.

The law does not, however, set a NADAC or acquisition-cost reimbursement floor, and notably it does not ban spread pricing (it requires disclosure of the practice instead). It is therefore a licensure-and-transparency regime rather than a floor.

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