Bill > H1234

This bill introduces comprehensive regulations for pharmacy benefit managers (PBMs), focusing on increasing transparency, fairness, and consumer protection in prescription drug pricing and management. The legislation defines key terms like "estimated rebates" and "spread pricing," and requires PBMs to pass at least 80% of estimated drug rebates to insureds by reducing their out-of-pocket costs at the point of sale. The bill establishes that PBMs have a duty to perform services with care, professionalism, and good faith, and must maintain adequate pharmacy networks that provide convenient patient access. It prohibits PBMs from engaging in spread pricing (where they charge health plans different prices than they pay pharmacies), imposes strict rules on maximum allowable cost lists for generic drugs, and creates a formal grievance process for pharmacies to challenge reimbursement rates. The legislation also prevents PBMs from retroactively reducing pharmacy payments, restricts their ability to charge certain fees, and allows pharmacists to provide patients with information about more affordable drug alternatives. Violations can result in significant financial penalties, including a 10% surcharge on prescription drug reimbursements, and the bill empowers the state commissioner to audit and enforce these new regulations, ultimately aiming to make prescription drug pricing more transparent and affordable for consumers.

Budget and Finance, Business and Industry

https://malegislature.gov/Bills/194/H1234