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HB20-1078

Pharmacy Benefit Management Firm Claims Payments

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

The bill specifies the amount that a pharmacy benefit management firm (PBM) is required to reimburse a pharmacy for clean claims and reasonable dispensing fees.

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. 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: This summary applies to this bill as introduced.)

Status

Introduced
Under Consideration

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Bill Text

Sponsors

Sponsor Type Legislators
Prime Sponsor

Rep. S. Jaquez Lewis, Rep. K. Mullica
Sen. F. Winter

Sponsor

Co-sponsor

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