Bill > SB99

This bill introduces comprehensive new regulations for Pharmacy Benefit Managers (PBMs) in Alabama, significantly expanding oversight and restricting certain business practices. The bill defines numerous terms and establishes strict requirements for how PBMs can operate, including mandating that they reimburse pharmacies at rates based on the National Average Drug Acquisition Cost, pass 100 percent of pharmaceutical manufacturer rebates to clients, and prohibit practices like steering patients to specific pharmacies or charging excessive fees. The legislation also creates new enforcement mechanisms, allowing the Insurance Commissioner to levy civil penalties of at least $1,000 per violation and enabling pharmacies, healthcare providers, insurers, and patients to bring civil actions against PBMs for violations. Key restrictions include preventing PBMs from basing reimbursements on outcomes, initiating fraud investigations without commissioner approval, imposing additional requirements on certain pharmacies, and practicing "spread pricing" - where PBMs charge clients more for prescription drugs than they pay pharmacies. The bill also amends audit procedures to provide more protections for pharmacies during financial reviews, with specific guidelines about audit sample sizes, documentation requirements, and recoupment processes. The new regulations are set to take effect on October 1, 2025, and aim to increase transparency and fairness in prescription drug pricing and distribution.

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