Bill > HB1850

This bill modifies provisions related to pharmacies by establishing new regulations for pharmacy audits and pharmacy benefits managers (PBMs). Key changes include extending the notice period for audits to fourteen days, requiring audits involving clinical judgment to be conducted by or in consultation with a licensed pharmacist, and allowing pharmacies to correct clerical errors within thirty days to avoid recoupment. The bill also limits audits to forty unique prescriptions and two hundred claims, restricts audits to twice per year, and clarifies that recoupments cannot be based on requirements exceeding professional duties. It also introduces new rules for PBMs regarding Maximum Allowable Cost (MAC) lists, requiring them to update pricing information at least every seven days and to have a procedure for pharmacies to appeal MAC pricing disputes. Furthermore, the bill mandates that PBMs disclose their affiliated pharmacies and the pricing differences between them and non-affiliated pharmacies, and requires PBMs to pass through 100% of rebates and discounts to health plans, aligning with federal requirements starting in 2027. Finally, it establishes specific reimbursement requirements for "critical-access care pharmacies," ensuring they are paid at least their actual cost plus a dispensing fee, and provides an appeal process for these pharmacies.