Pharmacy Benefit Manager Practices

Beginning January 1, 2027, the act:

• Allows a pharmacy benefit manager (PBM) to earn income derived from the assessment of a flat-dollar service fee for the provision of a prescription drug;
• Prohibits a PBM from earning income based on the price or cost of a prescription drug;
• Prohibits a PBM from designing a formulary to favor a certain branded pharmaceutical or biologic;
• Requires a PBM to be reimbursed by a health benefit plan for lowering the plan's prescription drug spending over a given period of time and for the direct services the PBM provides to the plan;
• Sets the amount that a PBM shall reimburse an unaffiliated pharmacy or a PBM-affiliated retail, mail order, or specialty pharmacy for a prescription drug; and
• Requires a contract between a PBM and a health benefit plan to contain a provision where the PBM discloses prescription drug cost information to the health benefit plan and a provision authorizing the health benefit plan to execute an audit to validate compliance with the contract.
  (Note: This summary applies to this bill as enacted.)