Bill > SB2047

This bill establishes requirements for pharmacy benefit managers (PBMs), which are companies that manage prescription drug benefits for health plans and employers, to ensure fairer reimbursement practices for pharmacies. Specifically, it mandates that PBMs must disclose the data sources for their Maximum Allowable Cost (MAC) lists, which are the maximum amounts they will pay pharmacies for certain drugs, and provide these lists to contracting pharmacies upon request. The bill also requires that drugs on a MAC list must be generally available, have appropriate ratings, and not be obsolete, and that PBMs must update their MAC lists at least weekly. Furthermore, it creates a process for pharmacies to appeal MAC prices if they are lower than wholesale costs or if the drug doesn't meet the availability criteria, and allows pharmacies to reverse and rebill claims if an appeal is successful, ensuring they are reimbursed at the correct rate. The Insurance Commissioner is authorized to fine PBMs for violations and establish a process for handling complaints, with funds appropriated to the Department of Commerce and Consumer Affairs to implement these changes. This legislation aims to increase transparency in drug pricing and protect independent pharmacies and consumers from potentially unfair reimbursement practices and copay clawbacks, which occur when a PBM charges a patient a higher copay than the actual drug cost and keeps the difference.