The legislation is designed to protect patient interests by prohibiting health care service plans from calculating an enrollee's cost-sharing based on amounts exceeding the actual retail price of prescription drugs. Effective from January 1, 2025, this provision is aimed at ensuring affordable access to necessary medications. Additionally, the bill seeks to preserve competitive markets and maintain the authority of the Attorney General over antitrust concerns, thereby supporting consumer protection goals.
Senate Bill 966, introduced by Senators Wiener and Wahab, aims to amend and expand the regulation of pharmacy benefit managers (PBMs) in California under existing health and safety codes. The bill mandates that PBMs must apply for a license from the Department of Insurance by January 1, 2027, establishing a regulatory framework intended to enhance transparency and accountability for these entities. This involves filing mandatory reports on product benefits and financial details that promote better oversight of their operations and impact on drug pricing.
The sentiment surrounding SB 966 appears to be generally supportive among healthcare advocates and policymakers who seek to contain drug costs and enhance the transparency of PBM practices. However, concerns have been raised about the implications of increased regulation on PBMs and whether it may inadvertently lead to unintended consequences for accessibility or bureaucratic complexities in the healthcare system. Advocates for reforms argue that these measures are essential in curbing the rising costs of prescription drugs in California.
Notable points of contention include worries from some stakeholders regarding the administrative burdens that could arise for PBMs and other stakeholders due to the increased compliance requirements outlined in the bill. Furthermore, the confidentiality provisions regarding the reports submitted by PBMs, although intended to protect sensitive business information, have raised questions about transparency in the healthcare market and accountability in drug pricing practices.