Bills › 90th General Assembly
Relating to pharmacy benefits managers, pharmacies, and prescription drug benefits, and including applicability provisions
Topics:Business & economyHealth carePrescription drug prices
Where it is now
- Done: IntroducedFebruary 20, 2023
- Done: SubcommitteeFebruary 21, 2023
- Stopped: Senate committeeDied when the General Assembly ended
- Next: Passes the Senate
- Next: House committee
- Next: Passes the House
- Next: To the Governor
- Next: Signed into law
Died when the session ended The 2024 session adjourned on April 19, 2024, the General Assembly’s last regular session. Bills that didn’t pass both chambers died. What’s a funnel?
What’s in it
AI summary Pharmacy benefit managers would be prohibited from forcing people to use mail-order pharmacies or charging different prices based on which pharmacy a person chooses. Any money a person pays for their medicine must count toward their health plan's deductible. Additionally, these managers must give pharmacies online access to price lists and a way to appeal those prices.1
Read the official explanation
This bill relates to pharmacy benefits managers (PBM), pharmacies, and prescription drug benefits. The bill requires that any amount paid by a covered person for a drug in the circumstances detailed in the bill must be applied to any deductible imposed by the covered person’s health benefit plan in accordance with the plan’s coverage documents. Under the bill, a covered person cannot be prohibited from filling a drug order at any pharmacy located in the state if the pharmacy accepts the same terms and conditions as the covered person’s benefit plan. A PBM cannot impose different cost-sharing or additional fees on a covered person based on the pharmacy at which a covered person fills their prescription. A PBM cannot require a covered person, as a condition of payment or reimbursement, to purchase pharmacy services, including drugs, exclusively through a mail-order pharmacy. The bill requires a PBM to provide each pharmacy in a network access to the maximum allowable cost list (MACL) to which the pharmacy is subject via a secure accessible internet site. The bill requires a PBM to provide a process for pharmacies to appeal a maximum allowable cost, or a reimbursement made under a MACL. The requirements for the appeal process are detailed in the bill. The bill applies to PBMs that manage a health carrier’s prescription drug benefit in the state on or after the effective date of the bill.
Senate subcommittee
Named February 21, 2023. On February 27, 2023 it recommended amendment and passage. [].
Three legislators hear a bill first and recommend what the committee should do; it’s the best time to weigh in. How to take part
1 written public comment to its subcommittee: February 27, 2023 (1) · on the Legislature’s site
Family tree
90th General Assembly
Picked up later
Earlier and later bills are matched by wording or an identical title.
Tried before
This idea has been filed in an earlier General Assembly. None got through a chamber.
- HF 729 Relating to pharmacy benefits managers, pharmacies, and prescription drug benefits, and in…89th General Assembly · Approved by committee · same titleCleared committee
- SF 2092 Relating to pharmacy benefits managers, pharmacies, and prescription drug benefits, and in…89th General Assembly · Renumbered as SF 2231 · same titleCleared committee
- SF 2231 Relating to pharmacy benefits managers, pharmacies, and prescription drug benefits, and in…89th General Assembly · Withdrawn · same titleDidn’t advance
Similar bills this General Assembly
- HF 213 Relating to pharmacy benefits managers, pharmacies, and prescription drug benefits, and in…91st General Assembly · In committeeVery similar
- HF 2473 Relating to pharmacy benefits managers, pharmacies, and prescription drug benefits, and in…90th General Assembly · In committeeVery similar
Matched by wording or an identical title.