Relating to pharmacy benefit managers and the cost of prescription drug benefits, and including applicability provisions

The bill provides that if a health carrier provides a prescription drug benefit to a covered person under a health benefit plan, and the prescription drug benefit is managed by a pharmacy benefit manager, the pharmacy benefit manager must reduce, at the point of sale, any cost sharing for a prescription drug by either a dollar amount that equals not less than percent of the aggregate rebates received by the pharmacy benefit manager for that particular prescription drug, or a dollar amount greater than that amount. The bill prohibits a pharmacy benefit manager from increasing a participating pharmacy’s, participating pharmacist’s, or other participating dispenser’s cost of participation to offset the required reduction in cost sharing. A pharmacy benefit manager is prohibited from disclosing any information regarding the actual amount of rebates the pharmacy benefit manager received for a specific drug, or from a specific pharmaceutical manufacturer in order to comply with the cost-sharing requirement. Rebate information is protected as a trade secret and is a confidential record. A pharmacy benefit manager is also required to have an agreement with the pharmacy benefit manager’s third-party vendors and downstream entities as necessary to ensure the information is protected as a trade secret. The bill requires the commissioner of insurance to adopt rules as necessary to administer the provisions of the bill. The bill also allows the commissioner to take any action within the commissioner’s authority to enforce compliance with the provisions of the bill. The bill is applicable to health benefit plans that are delivered, issued for delivery, continued, or renewed in this state on or after January 1, 2021.