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Drug Pricing Review

In 2018, the HPC was granted the authority to support MassHealth, the Commonwealth’s Medicaid program, in its price negotiations with drug manufacturers. If MassHealth is unable to reach a supplemental rebate agreement with a drug manufacturer, they may refer the drug to the HPC, which will then conduct reviews of any high-cost drugs referred. In drug pricing reviews, the HPC conducts a public assessment of the drug referred and whether the price is unreasonable or excessive in relation to the value. 

Statutory Authority

Massachusetts law grants authority to the Executive Office of Health and Human Services and the MassHealth program to negotiate directly with pharmaceutical drug manufacturers for supplemental rebates. If MassHealth is not able to negotiate a supplemental rebate agreement, and the drug has a post-rebate cost to MassHealth of more than $25,000 per utilizer per year or $10 million in aggregate annually, MassHealth can initiate a process to refer the drug to the HPC to investigate the manufacturer’s pricing. 

Upon a referral from MassHealth, the HPC is authorized to make an assessment of a referred drug’s pricing and value. The HPC can collect information related to the referred manufacturer’s pricing, including through a standard reporting form – developed by HPC with input from manufacturers. Based on this and other available information, the HPC may identify a proposed value for the drug and ultimately determine whether the manufacturer’s pricing of the drug is unreasonable or excessive in relation to the HPC’s proposed value for the drug. In addition, the HPC may, in consultation with MassHealth, propose a supplemental rebate for the drug.

More Information

For questions regarding the drug pricing review process, please contact staff by email at [email protected] or by phone at (617) 979-1400.

M.G.L. c. 6D, § 8A

Final Drug Pricing Review Regulation (958 CMR 12.00)

Standard Reporting Form