Pharmacy Benefits Prompt Pay Act; revise various provisions of.
HB1096 significantly impacts state laws by prohibiting PBMs from engaging in discriminatory reimbursement practices that affect entities in the 340B Program. Additionally, it requires PBMs to provide a reasonable administrative appeal process for pharmacies to contest underpayment issues. With these amendments, the bill aims to protect local pharmacies and ensure they receive fair compensation for their services. It also provides that all rebates and payments received by PBMs must be passed on to the plan sponsors, enhancing transparency in drug pricing.
House Bill 1096 aims to amend the Pharmacy Benefit Prompt Pay Act, revising various provisions to enhance the regulatory framework governing pharmacy benefit managers (PBMs) in Mississippi. The bill includes provisions that define new terms and refine existing definitions to clarify the operations of PBMs and their interactions with pharmacies, health insurers, and patients. Key elements of the bill focus on ensuring equitable reimbursement rates for pharmacies participating in the Federal 340B Drug Discount Program, mandating that PBMs do not reimburse at rates lower than those offered to non-340B entities.
Notably, the bill addresses considerations around pricing integrity in the pharmacy sector, prompting discussions about the balance of power between PBMs and pharmacies. Proponents argue it safeguards the interests of pharmacies and patients by enforcing fairer billing practices, while opponents may fear it could drive higher costs for health plan sponsors. Legislative debates are likely to focus on the implications these measures have for cost control within the healthcare system, with supporters highlighting the necessity of equitable treatment and detractors cautioning against potential unintended consequences.
The act calls for stringent enforcement measures, with the State Board of Pharmacy authorized to conduct examinations of PBMs and issue penalties for those that fail to comply with the new reimbursement regulations. This amendment seeks to ensure that compliance oversight is proactive, thus supporting the fair treatment of pharmacies throughout the state and holding PBMs accountable for their reimbursement practices.