Bill > SB50

This bill: 1. Requires the Department for Medicaid Services to establish and directly administer an outpatient pharmacy benefit program for all Medicaid beneficiaries. The department may contract with a third-party administrator (the "state pharmacy benefit manager") on a fee-for-service basis to administer the program. 2. Mandates that managed care organizations contracting with the department for Medicaid services must utilize the state pharmacy benefit manager to administer pharmacy benefits for Medicaid recipients. 3. Directs the department to establish a single preferred drug list, reimbursement methodologies, and dispensing fees that the state pharmacy benefit manager must use. 4. Imposes restrictions on the state pharmacy benefit manager, including prohibiting the use of "spread pricing" and requiring pass-through pricing. 5. Creates a Technical Advisory Committee on Pharmacy to make recommendations to the department on the reimbursement methodologies and dispensing fees. 6. Temporarily prohibits existing pharmacy benefit managers from making certain changes to reimbursement rates, fees, and pharmacy networks while the new state-administered program is being established. The bill is an effort to reform the administration of pharmacy benefits in the state Medicaid program, with the goal of improving transparency and reducing costs.

Budget and Finance, Health and Social Services

https://apps.legislature.ky.gov/record/20RS/sb50.html