Bill > SF4062

This bill aims to increase transparency and fairness in the pharmaceutical industry by prohibiting "spread pricing," a practice where a pharmacy benefit manager (PBM) charges a health plan a different price for a prescription drug than what it pays the pharmacy. PBMs are companies that manage prescription drug benefits on behalf of health insurers, employers, and other plan sponsors. The bill also increases PBM license application and renewal fees, limits the sources of income for PBMs to a defined "pharmacy benefit management fee" that is not tied to drug prices or rebates, and imposes fiduciary duties on PBMs, meaning they must act in the best interest of health carriers. Additionally, it mandates that PBMs must reimburse pharmacies at least the national average drug acquisition cost or wholesale acquisition cost for the drug ingredient, and establishes stricter rules for how PBMs determine and update maximum allowable cost (MAC) pricing, which is the maximum amount a PBM will reimburse a pharmacy for generic drugs. The bill also includes provisions to prevent PBMs from unfairly penalizing pharmacies or enrollees based on ownership interests and requires PBMs to disclose certain financial information to the commissioner of commerce. Finally, it appropriates funds to the commissioner of commerce for increased staff to investigate and enforce these new regulations.