LEGISLATIVE SERVICES AGENCY
OFFICE OF FISCAL AND MANAGEMENT ANALYSIS
FISCAL IMPACT STATEMENT
LS 7630 NOTE PREPARED: Jan 10, 2025
BILL NUMBER: HB 1606 BILL AMENDED:
SUBJECT: Pharmacy benefit managers.
FIRST AUTHOR: Rep. McGuire BILL STATUS: As Introduced
FIRST SPONSOR:
FUNDS AFFECTED: GENERAL IMPACT: Pending
DEDICATED
FEDERAL
Summary of Legislation: Prohibits a pharmacy benefit manager from taking certain actions. Requires a
pharmacy benefit manager to submit a report to the insurance commissioner every six months. (Current law
requires a pharmacy benefit manager to submit the report annually.) Provides that if a contract holder
requests an audit of compliance with the contract from a pharmacy benefit manager, the pharmacy benefit
manager must provide the audit requested to the contract holder not later than 30 business days after
receiving the request. Removes the provision specifying that the files or forms disclosed to the contract
holder by the pharmacy benefit manager as part of an audit of compliance with the contract may be modified
to redact trade secrets. Establishes civil penalties that the department of insurance (department) shall impose
for a violation of the provisions concerning pharmacy benefit managers. Requires a pharmacy benefit
manager to provide additional information in the pharmacy benefit manager's report to the department.
Requires, after June 30, 2025, a health payer to include information relating to prescription drug pricing in
the data submitted to the all payer claims data base by the health payer. Requires a health plan to credit
toward a covered individual's deductible and annual maximum out-of-pocket expenses any amount the
covered individual pays directly to any health care provider for a medically necessary covered health care
service if a claim for the health care service is not submitted to the health plan and the amount paid by the
covered individual to the health care provider is less than the average discounted rate for the health care
service paid to a health care provider in the health plan's network.
Effective Date: July 1, 2025; January 1, 2026.
Explanation of State Expenditures: As of the above date, the fiscal analysis of this bill has not been
completed. Please contact the Office of Fiscal and Management Analysis for an update of this fiscal impact
statement.
Explanation of State Revenues:
Explanation of Local Expenditures:
HB 1606 1 Explanation of Local Revenues:
State Agencies Affected:
Local Agencies Affected:
Information Sources:
Fiscal Analyst: Jason Barrett, 317-232-9809.
HB 1606 2