Bill > HB2270

This bill amends the Pharmacy Audit Integrity and Transparency Act to redefine "specialty drug" as a prescription medication for complex or chronic conditions requiring special handling, coordination, or patient education that a retail pharmacy cannot reasonably manage, and clarifies "spread pricing" as a model where a Pharmacy Benefits Manager (PBM) charges a health plan more than they pay the pharmacist for drugs. Crucially, it establishes a "State pharmacy benefits manager" by requiring the Department of Human Services to contract with a single third-party administrator by July 31, 2026, to manage all pharmacy benefits for Medicaid recipients, including those in managed care organizations. This State PBM must undergo a competitive procurement process that includes disclosing potential conflicts of interest and affiliations, and its contract will prohibit practices like steering enrollees to affiliated pharmacies, requiring exclusive use of mail-order or specialty pharmacies unless necessary, retroactively denying claims, engaging in spread pricing, and charging certain fees to pharmacies. The contract will also mandate that the State PBM pay pharmacies at least the National Average Drug Acquisition Cost or wholesale acquisition cost plus a professional dispensing fee determined by a cost-of-dispensing survey, establish a fiduciary duty to the Department and pharmacies, and use "pass-through pricing," meaning the health plan is charged the same price the PBM pays the pharmacy.