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Pharmacy Benefit Management Firm Claims Payments

Concerning prescription drug claims submitted by a pharmacy, and, in connection therewith, prohibiting retroactive fees.
2020 Regular Session
Health Care & Health Insurance
Bill Summary

The bill specifies the amount that prohibits a pharmacy benefit management firm (PBM) is required to reimburse from reimbursing a pharmacy for clean claims and reasonable dispensing fees in an amount less than the amount that the PBM reimburses any affiliate for the same pharmacy services.

The bill also prohibits PBMs from retroactively reducing payment on a clean claim submitted by a pharmacy unless the PBM determines, through an audit conducted in accordance with state law, that the claim was not a clean claim or the retroactive reduction is to correct a clerical error . Health insurers that contract with PBMs must ensure that the PBMs are complying with this prohibition. and the reporting requirements and are subject to penalties for failure to do so.

(Note: Italicized words indicate new material added to the original summary; dashes through words indicate deletions from the original summary.)

(Note: This summary applies to the reengrossed version of this bill as introduced in the second house.)




Bill Text

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