Bill > SB1500

This bill aims to regulate pharmacy benefit managers (PBMs), which are entities that manage prescription drug benefits for health plans. It prohibits PBMs from conditioning payments to providers on certain conditions, such as post-transaction reconciliations or internal settlement processes, and prevents providers from bearing the financial risk of delayed or failed funding from third parties after a claim has been processed. The bill mandates that PBMs, referred to as "payors" in the legislation, must pay "clean claims" – which are claims submitted correctly and without disputes – within 30 calendar days of receipt. Furthermore, payors are required to provide providers with a clear, itemized accounting of all payments, detailing information like claim identifiers, dates of service, amounts paid by all parties, adjustments, and any interest accrued. The bill also prohibits payors from bundling claims to obscure payment details, providing only summary data, charging fees for access to claim accounting, delaying payments beyond the specified timeframe, retroactively repricing or withholding payments after adjudication (except as legally permitted), conditioning payments on post-adjudication audits, or extending payment timelines through contracts that contradict the bill's provisions. Any payments not made within the 30-day window will automatically accrue interest at a rate of 10% per 30 days on the unpaid amount. The Attorney General is authorized to levy fines of up to $10,000 per violation, and any contract that attempts to waive or limit these rights will be considered void. The bill also allows the Attorney General to create necessary rules for enforcement and will take effect on November 1, 2026.