Pharmacy Benefit Management Firm Claims Payments
Beginning January 1, 2021, the act:
- Prohibits a pharmacy benefit management firm (PBM) from reimbursing a pharmacy in an amount less than the amount that the PBM reimburses any affiliate for the same pharmacy services;
- Prohibits PBMs from retroactively reducing payment on a clean claim submitted by a pharmacy unless as the result of an audit conducted in accordance with state law; and
- Requires health insurers that contract with PBMs to ensure that the PBMs are complying with this prohibition.
The division of insurance is authorized to promulgate rules to establish the manner in which carriers and pharmacy benefit management firms are required to show compliance with the act.
(Note: This summary applies to this bill as enacted.)