Bill > HB2225

This bill aims to increase transparency and fairness in prescription drug benefit plans by prohibiting discrimination against pharmacies and pharmacists in their participation, referrals, reimbursement, or indemnification, provided they are operating within their legal scope. It also establishes new requirements for how prescription drug costs are handled for beneficiaries, mandating that any rebates received by pharmacy benefit managers (PBMs) – companies that manage prescription drug benefits for health insurers – must be used to reduce a beneficiary's out-of-pocket costs at the point of sale, with any remaining savings passed on to lower premiums. For prescription drug plans that are executed, amended, adjusted, or renewed on or after July 1, 2027, PBMs will be required to use "pass-through pricing," meaning the amount paid by the plan to the PBM for a drug is the same as what the PBM pays the pharmacy, or they can use "spread pricing" only if the savings are passed on to the plan. Furthermore, the bill sets minimum reimbursement rates for pharmacies, requiring PBMs to reimburse pharmacies at least what they pay their own affiliated pharmacies or at a rate based on national average drug acquisition costs plus a professional dispensing fee, similar to the Hawaii Medicaid fee schedule. The bill also clarifies the definition of a "third-party payor" in this context and grants the insurance commissioner the authority to fine PBMs and plan providers up to $10,000 per violation and order corrective actions or restitution for non-compliance with these new provisions.