Bill > HF3931

This bill aims to regulate the practices of Pharmacy Benefit Managers (PBMs), which are companies that manage prescription drug benefits on behalf of health insurers and other payers. Key provisions include prohibiting PBMs from "spread pricing," a practice where they charge a health plan a different price for a drug than what they pay the pharmacy, and establishing a clear definition for "pharmacy benefit management fee" as a flat, defined fee for services that does not exceed the value of the service provided and is not tied to drug prices or rebates. The bill also increases the application and renewal fees for PBM licenses, limits the sources from which PBMs can derive income to only these defined fees, and imposes a fiduciary duty on PBMs, meaning they must act in the best interest of health carriers. Additionally, it requires PBMs to adhere to specific performance standards, prohibits certain fees charged to pharmacies for claim adjudication, and mandates that PBMs reimburse pharmacies at least the national average drug acquisition cost or wholesale acquisition cost for ingredient drugs. The bill also strengthens transparency requirements for PBMs, requires them to disclose ownership interests in pharmacies, and prohibits them from offering financial incentives to enrollees for using pharmacies they own or are affiliated with, while also preventing them from limiting medication access for non-affiliated pharmacies. Furthermore, it enhances the process for pharmacies to dispute "maximum allowable cost" (MAC) pricing, which is the maximum price a PBM will reimburse a pharmacy for a generic drug, and prohibits retroactive claim adjustments unless specific conditions like fraud or billing errors are met. Finally, the bill appropriates funds to the commissioner of commerce to hire staff for investigating and enforcing these new regulations concerning PBMs.