Pharmacy benefit managers and health carriers required to use prescription drug rebates and other compensation to benefit covered persons, and report required.
Impact
The enactment of HF1075 will significantly alter the interaction between PBMs, health carriers, and patients. By requiring that financial compensation from drug manufacturers be passed on immediately to consumers, the bill is expected to lower the effective cost of prescription drugs at the point of sale. This could lead to a reduction in overall healthcare spending for individuals who rely on these medications, thereby improving access to necessary prescriptions for many state residents.
Summary
HF1075 mandates that pharmacy benefit managers (PBMs) and health carriers must remit all compensation received from drug manufacturers directly to the covered persons at the point of sale. This compensation includes any financial benefits such as rebates and discounts aimed at reducing the out-of-pocket costs incurred by individuals for their prescription drugs. The bill seeks to improve transparency and ensure that patients directly benefit from rebates and discounts offered by drug manufacturers.
Contention
While there is broad support for the intention of HF1075 to reduce out-of-pocket costs, concerns exist about the implications for the financial structures of PBMs and health carriers. Some stakeholders argue that the requirement may disrupt existing contracts and relationships between manufacturers and PBMs, potentially leading to higher premiums or changes in how drugs are covered under insurance plans. Additionally, there are discussions regarding the administrative burdens that the reporting requirements may impose on these entities.
Future_provisions
The bill stipulates that starting March 1, 2026, PBMs and health carriers will need to report their compliance with this new regulation to the state's commissioner. This provision aims to enforce accountability and transparency in the implementation of the new mandates, ensuring that covered persons receive the intended financial benefits. The bill will take effect on January 1, 2026, allowing stakeholders time to adjust to these significant changes.
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Pharmacy benefit managers and health carriers usage of prescription drug rebates and other compensation requirement to benefit covered persons provision
Pharmacy benefit managers and health carriers required to use prescription drug rebates and other compensation to benefit covered persons, and report required.
Manufacturers required to report and maintain prescription drug prices, filing of health plan prescription drug formularies required, health care coverage provisions modified, prescription benefit tool requirements established, and prescription drug benefit transparency and disclosure required.
Pharmacy benefit managers and health carriers required to include lower-cost drugs in their formularies, and formulary structure and formulary tiering for each health plan required to give preference to drug with lowest out-of-pocket cost to patient.
Pharmacy benefit manager business practices modified, pharmacy benefit manager general reimbursement practices established, and maximum allowable cost pricing requirements modified.