Bill > H7189

This bill requires pharmacy benefit managers (PBMs), which are companies that manage prescription drug benefits on behalf of health insurers, to provide fair reimbursement to pharmacies and pharmacists that are not affiliated with them. Specifically, PBMs cannot pay non-affiliated pharmacies less than they pay their own affiliated pharmacies for the same drug or service, considering all payments and adjustments. The bill also prohibits PBMs from using contract terms, payment methods, or performance standards that result in lower reimbursement rates for non-affiliated pharmacies. To ensure compliance, PBMs must provide reimbursement data to the office of the health insurance commissioner (OHIC) upon request, and this rule applies to Medicaid managed care organizations as well. The OHIC is empowered to create rules to enforce these provisions, and the attorney general will also be involved in enforcement, with the bill taking effect immediately upon passage.

Health and Social Services

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