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The effective date for bills enacted without a safety clause is August 6, 2025, if the General Assembly adjourns sine die on May 7, 2025 (unless otherwise specified). Details

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HB25-1094

Pharmacy Benefit Manager Practices

Concerning pharmacy benefit manager practices that affect prescription drug costs.
Session:
2025 Regular Session
Subject:
Health Care & Health Insurance
Bill Summary

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;
  • 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;
  • Requires a PBM to credit income derived from a source other than a flat-dollar service fee to a health insurance carrier (carrier) or a self-funded health benefit plan; 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.
    (Note: This summary applies to this bill as introduced.)

Status

Introduced
Under Consideration

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Bill Text