State pharmacy benefits manager; DMAS to select & contract with a third-party administrator to serve

Removed the requirement to select and contract with a single PBM by July 1, 2026.

Added deadline for DMAS to report findings to the Governor and General Assembly by December 1, 2025.

Added requirement for DMAS to engage an independent consultant with specific experience in Medicaid fraud control and single PBM models to evaluate the transition.

Removed detailed contract requirements including fiduciary duties, pass-through pricing, transparency requirements, and prohibition of spread pricing that were previously mandated in the enacted version.

Changed the bill from an operational mandate to a study and evaluation directive, shifting focus from implementation to analysis.

Header information changed from 'Senate Substitute' to 'Conference Substitute' with updated proposal date (February 22, 2025) and joint patron attribution (Delegates Callsen and Kilgore), reflecting the bill's passage through conference committee.

Minor formatting adjustments including spacing, line breaks, and document numbering were standardized between the two versions.

Several blank lines and spacing inconsistencies present in the Senate version were removed in the Conference version.

The Conference version includes additional page markers and document identifiers (25108043D, HB2610H3) not present in the Senate version.

Updated bill header to reflect Senate Committee on Education and Health consideration instead of House Committee on Appropriations, with revised date and page numbering.

Added page number markers and formatting consistent with Senate substitute markup.

Removed House-specific header information including 'HOUSE SUBSTITUTE' and '25106608D' tracking number.

Changed the proposing committee from 'House Committee on Health and Human Services' to 'House Committee on Appropriations' and updated the patron from 'Delegates Callsen and Kilgore' to 'Delegate Callsen'.

Updated the bill identifier number from '25105973D' to '25106608D'.

Changed the amendment date from January 28, 2025 to January 31, 2025.

Added blank lines and formatting adjustments throughout the document.

Document formatting changed from Enrolled version to House Substitute version with added line numbers and committee attribution information.

Header information updated to reflect House Committee on Health and Human Services substitute status with delegate patron information.

Page layout and spacing adjusted throughout the document to match substitute bill formatting standards.

Added new section 32.1-325.5 requiring the Department to select and contract with a single state pharmacy benefits manager by December 31, 2025, to administer all pharmacy benefits for Medicaid recipients.

Added requirement that the state pharmacy benefits manager must use pass-through pricing and prohibit the use of spread pricing, with full transparency in drug costs, rebates, and fees.

Added definitions for 'pharmacy benefits manager', 'spread pricing', and 'state pharmacy benefits manager' to clarify the new program requirements.

Formatting changes from introduced draft to enrolled version, including page headers, line numbers, and official act language, but no substantive policy changes.