Bill > SB852

This bill aims to regulate pharmacy benefit managers (PBMs) by establishing several key protections for pharmacies, pharmacists, and patients. The bill allows pharmacies to provide patients with information about lower-cost alternatives without penalty and prohibits PBMs from collecting cost-sharing charges that exceed the total submitted charges. It specifically protects 340B entities (healthcare organizations that can purchase discounted outpatient drugs) by requiring PBMs to reimburse them at the same rates as non-340B pharmacies and preventing discriminatory practices. The bill mandates that PBMs cannot reimburse pharmacies for prescription drugs at rates lower than the national average drug acquisition cost plus a $10.49 professional dispensing fee, with an exemption starting in 2026 under certain conditions. Additionally, the legislation requires that a patient's cost-sharing be calculated based on rebates received and ensures that patients will not pay more at the point of sale than the lesser of their health plan's cost share or the cash price, with the cash price being considered payment in full if it is lower. The bill also prohibits PBMs from implementing various unfair practices, such as discriminating against pharmacies, basing reimbursement on patient outcomes, or imposing retroactive fees, ultimately aiming to create more transparency and fairness in prescription drug pricing and reimbursement.