Healthcare

Pharmacy benefits managers; various requirements; report. Prohibits a pharmacy benefits manager from (i) reimbursing a pharmacy in an amount less than the national average drug acquisition cost for the prescription drug or pharmacy service at the time the drug is administered or dispensed, plus a professional dispensing fee; (ii) basing pharmacy reimbursement for prescription drugs on patient outcomes, scores, or metrics; (iii) imposing a point-of-sale or retroactive fee on a pharmacy, pharmacist, or covered individual; (iv) receiving deductibles or copayments; (v) redirecting any prescription drug claims submitted by a pharmacy to any third-party discount card program, cash discount program, or any other non-insurance adjudication platform; (vi) using policy agreements incorporation into a pharmacy agreement, to materially change, alter, or modify the pharmacy agreement, reimbursement rates, payment terms, or other financial obligations; (vii) prohibiting a pharmacy from providing an individual certain information; (viii) charging a pharmacy a fee related to participation in a pharmacy network; (ix) requiring multiple specialty pharmacy accreditations as a prerequisite for participation in a pharmacy network that dispenses specialty drugs; or (x) deriving any revenue from a pharmacist, pharmacy, or covered individual in connection with performing pharmacy benefits management services. The bill requires a pharmacy benefits manager to calculate a covered individual's out-of-pocket cost for a covered prescription drug based on the net price of the prescription drug after taking into account all retained rebates associated with the prescription drug. The bill adds certain information to be included in a report that pharmacy benefit managers are currently required to submit and requires such report to be filed quarterly rather than annually. The bill also requires the Commissioner of Insurance to annually prepare and submit a report to the Governor and the General Assembly based on the information submitted by pharmacy benefits managers. Additionally, the bill prohibits a carrier or its pharmacy benefits manager from imposing any payment or condition relating to the purchase of pharmaceutical benefits from any pharmacy that is more costly or more restrictive than that which would be imposed upon such person if the same pharmaceutical services were purchased from a mail order pharmacy provider.