INSURANCE/HEALTH: Provides for transparency and compensation practices relative to pharmacy benefit managers (EN +$90,000 SG EX See Note)

Removed the creation of new statutory sections (1868-1871) and extensive definitions for terms like 'Maximum Allowable Cost List' and 'Effective rate pricing'.

Added a specific requirement that PBMs must calculate patient cost-sharing based on a price reduced by 100% of all rebates received.

Added a mandate that any rebate savings exceeding the patient's cost-sharing must be passed directly to the employer or health plan sponsor.

Changed the primary legislative intent from a broad PBM reform act to a specific transparency and rebate utilization report requirement.

The bill status changed from 'Reengrossed' to 'Enrolled,' and the list of sponsoring representatives and senators was updated to reflect the final legislative vote.

New definitions were added for 'Effective rate pricing,' 'Health benefit plan,' 'Local pharmacy,' 'Maximum Allowable Cost List,' 'NDC,' 'Pharmacist services,' 'Pharmacy,' 'Pharmacy benefit manager,' and 'Pharmacy benefits plan' to clarify regulatory standards.

The bill now explicitly requires health insurers to use 'Maximum Allowable Cost Lists' to set reimbursement rates for generic and multi-source brand drugs.

New provisions prohibit pharmacy benefit managers from retaining rebates and mandate transparency regarding compensation programs and reimbursement practices.

The bill authorizes the commissioner of insurance to examine PBM records and compensation programs to ensure fairness and compliance with new pricing standards.

The bill expands its scope to include provisions against patient steering and the creation of a fund, in addition to the previous focus on rebate transparency.

Four new representatives (Billings, Farnum, Schamerhorn, and Wyble) were added as co-sponsors to the bill.

The definition of 'Rebates' was restructured to explicitly include discounts and price concessions paid by manufacturers or other parties to pharmacy benefit managers after a claim is adjudicated.

The commissioner's power to examine pharmacy benefit manager records was updated to specifically include the aggregate amount paid to pharmacists for drugs, devices, or services.

Confidentiality requirements for information provided to the commissioner were strengthened to explicitly state that contract terms and proprietary information shall not be subject to disclosure under the Public Records Law.