Bill > HB0527

This bill amends existing Utah law concerning pharmacy benefits by adding a definition for "pharmacy acquisition cost," which is the net amount a pharmaceutical wholesaler charges for a drug, and by establishing new requirements for pharmacy benefit managers (PBMs), which are entities that manage prescription drug benefits for health plans. Specifically, PBMs must now make a searchable electronic list of drugs and their maximum allowable costs (MACs) available to network pharmacies upon request, and this list must include the national drug code (NDC) and the MAC for each drug. PBMs are also required to use current data from multiple sources to determine MACs, review and adjust them weekly, and provide a clear process for pharmacies to appeal MACs within 21 days of a claim adjudication, with PBMs having 14 business days to resolve these appeals. If an appeal is upheld or the PBM cannot prove a drug is available at or below the MAC, they must adjust the reimbursement for the appealing pharmacy, allow the pharmacy to resubmit the claim, and consider further action. The bill also introduces penalties for PBMs violating these provisions, allowing the commissioner to order forfeitures of up to $2,500 per violation, and sets an effective date of May 6, 2026.

Business and Industry, Health and Social Services

https://le.utah.gov/~2026/bills/static/HB0527.html