Relating to pharmacy benefits managers, pharmacies, and prescription drug benefits, and including applicability provisions

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.