Relating to the regulation of pharmacy benefits managers

This bill relates to the regulation of pharmacy benefits managers (PBMs). Under current law, a PBM owes a duty of good faith and fair dealing to third-party payors. The bill expands that duty to pharmacies. The bill prohibits retaliation by a PBM against a pharmacy based on the pharmacy’s exercise of any right or remedy, or on the pharmacy’s cooperation with the commissioner. Prohibited retaliation includes terminating or refusing to renew a contract with a pharmacy, subjecting a pharmacy to increased audits, or withholding or failing to promptly pay the pharmacy any money owed by the PBM. Current law prohibits a PBM from assessing, charging, or collecting any form of remuneration that passes from a pharmacist in a pharmacy network to the PBM. Under the bill, a PBM is prohibited from assessing, charging, or collecting any form of remuneration that passes from any pharmacist, regardless of whether the pharmacist is in a pharmacy network. Under current law, for each maximum allowable cost list that a PBM uses, a PBM shall update the maximum allowable cost list within seven days from the date of an increase of percent or more in the pharmacy acquisition cost of a prescription drug on the list. Under the bill, for each maximum allowable cost list that a PBM uses, a PBM shall update the maximum allowable cost list within seven days from the date of an increase of percent or more in the national average drug acquisition cost of a prescription drug on the list. The bill requires that the annual report provided by a PBM to the commissioner of insurance regarding prescription drug benefits provided to covered persons of each third-party payor with whom the PBM has contracted during the prior calendar year be in a format that does not publicly disclose the identity of a specific third-party payor, the price charged by a specific pharmaceutical manufacturer for prescription drugs, or the amount of rebates provided for prescription drugs.