Bill > HB4457

This bill aims to regulate Pharmacy Benefits Managers (PBMs), which are companies that manage prescription drug benefits on behalf of health insurers, by defining key terms and prohibiting certain practices. It specifically addresses "medically integrated pharmacies," which are pharmacies owned by or closely affiliated with specialty healthcare providers who treat complex conditions, and "specialty medications," which are drugs for chronic or rare diseases requiring specialized handling. The bill prevents PBMs from restricting patients from obtaining these specialty medications from their medically integrated pharmacy, or from steering patients towards pharmacies owned or preferred by the PBM. It also prohibits PBMs from discriminating against medically integrated pharmacies in network participation, reimbursement, or administrative requirements, and requires them to offer equal opportunities for network participation. Furthermore, PBMs must make their specialty pharmacy network standards available upon request and approve or deny applications within 30 days, with denials subject to appeal. The bill also mandates that PBMs allow patients to obtain specialty medications from their treating specialty provider's medically integrated pharmacy when the provider is actively managing their care, and requires PBMs to maintain records for five years to demonstrate compliance. Violations are considered unfair or deceptive acts, enforceable by the Attorney General, who is granted authority to investigate, issue demands, and pursue legal action, including seeking penalties and injunctions. The bill also clarifies that pharmacy networks cannot deny participation to medically integrated pharmacies if they meet certain accreditation standards.