Bill > H870

This bill aims to improve access to generic medications by establishing new regulations for pharmacy benefits managers (PBMs) and covered entities, which are organizations that manage prescription drug benefits. A key provision defines a "maximum allowable cost list" as a list of drugs or medical products for which a PBM or covered entity has set a maximum reimbursement amount for pharmacies. Before a drug can be placed on this list, it must be deemed therapeutically equivalent by the FDA or a similar recognized source, and there must be at least two therapeutically equivalent, multi-source drugs or one generic drug available from a manufacturer. The bill mandates that if a drug no longer meets these criteria, it must be removed from the list within three business days. Furthermore, PBMs and covered entities must provide contracted pharmacies with information about the sources used for maximum allowable costs, the specific costs for drugs, and, upon request, the entire maximum allowable cost lists. These lists must be updated at least every three business days and made available in an accessible format, with payments to pharmacies adjusted within two business days of updates. The bill also introduces a process for pharmacies to contest a maximum allowable cost if it's higher than the wholesale price or if the drug was improperly added to the list. Appeals must be resolved within seven business days, and if an appeal is successful, the maximum allowable cost will be adjusted retroactively for the appealing pharmacy and for all similar pharmacies in the network within three business days. Finally, PBMs and covered entities must provide information about the appeals process on their secure websites, and pharmacies are prohibited from disclosing maximum allowable cost lists to third parties, with limited exceptions for administrative organizations.