Pharmacy Benefit Manager Practices

The bill:

• Allows a pharmacy benefit manager (PBM) to earn income derived from the assessment of a flat-dollar service fee;
• Prohibits a PBM from earning income based on the cost of a prescription drug;
• Prohibits a PBM from designing a formulary to favor a certain branded pharmaceutical or biologic;
• Requires a PBM to credit pass the income derived from a source other than a flat-dollar service fee to a health insurance carrier (carrier) or a self-funded the health benefit plan beneficiaries ; and
• 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 PBM to make certain documents and data available to a carrier, a self-funded plan, or the commissioner of insurance upon request.
• Requires a contract between a PBM and a health benefit plan to contain a provision that requires the PBM to disclose 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: 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.)