Oklahoma 2025 Regular Session

Oklahoma Senate Bill SB789 Compare Versions

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Version 2 (New)

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3		-	ENGR. S. B. NO. 789 Page 1 1
	3	+	SENATE FLOOR VERSION - SB789 SFLR Page 1
	4	+	(Bold face denotes Committee Amendments) 1
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28		-	ENGROSSED SENATE
29		-	BILL NO. 789 By: Gollihare, Coleman, Alvord,
30		-	Jech, Murdock, Guthrie,
31		-	Bullard, Standridge,
32		-	Weaver, Pugh, Pederson,
33		-	Hamilton, Deevers, Paxton,
34		-	Prieto, Kern, Boren, Burns,
35		-	Stewart, Stanley, Haste,
36		-	Seifried, McIntosh, Kirt,
37		-	Brooks, Hines, Sacchieri,
38		-	Goodwin, Reinhardt, Hall,
39		-	Gillespie, and Bergstrom of
40		-	the Senate
	29	+	SENATE FLOOR VERSION
	30	+	February 20, 2025
41	31
42		-	and
43	32
44		-	~~Stinson~~, ~~Marti~~, ~~and Moore~~
45		-	~~of the House~~
	33	+	SENATE BILL NO. 789 By: Gollihare, Alvord, Coleman,
	34	+	and Jech
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50		-	[ pharmacy benefit managers - pharmacy audit -
51		-	records - network sharing - reimbursement rates - fee
52		-	increase - contracts - penalties - effective date ]
	39	+
	40	+
	41	+	An Act relating to pharmacy benefit managers ;
	42	+	amending 59 O.S. 2021, Section s 356.2, as amended by
	43	+	Section 2, Chapter 332, O.S.L. 2024 , 357, as amended
	44	+	by Section 4, Chapter 332, O.S.L. 2024, and 360, as
	45	+	amended by Section 6, Chapter 332, O.S.L. 2024 (59
	46	+	O.S. Supp. 2024, Section s 356.2, 357, and 360), which
	47	+	relate to pharmacy audit requirements , definitions,
	48	+	and contractual duties to provider ; permitting use of
	49	+	certain records without limitations of date or source
	50	+	for certain purposes; modifying definitions ; updating
	51	+	statutory language; prohibiting certain network
	52	+	sharing; establishing certain reimbursement rates for
	53	+	certain drugs; providing for fee increase;
	54	+	prohibiting certain contracts between certain
	55	+	parties; establishing penalties; disallowing
	56	+	contracts from violating certain provisions; and
	57	+	providing an effective date .
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58	63		BE IT ENACTED BY THE PEOPLE OF THE STATE OF OKLAHOMA:
59	64		SECTION 1. AMENDATORY 59 O.S. 2021, Section 356.2, as
60	65		amended by Section 2, Chapter 332, O.S.L. 2024 (59 O.S. Supp. 2024,
61	66		Section 356.2), is amended to read as follows:
62	67		Section 356.2. A. The entity conducting an audit of a pharmacy
63	68		shall:
64		-	1. Identify and specifically describe the audit and appeal
65		-	procedures in the pharmacy contract. Prescription claim
66		-	documentation and record -keeping requirements shall not exceed the
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68		-	ENGR. S. B. NO. 789 Page 2 1
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	96	+	1. Identify and specifically describe the audit and appeal
	97	+	procedures in the pharmacy contract. Prescription claim
	98	+	documentation and record -keeping requirements shall not exceed the
93	99		requirements set forth by the Oklahoma Pharmacy Act or other
94	100		applicable state or federal laws or regulations;
95	101		2. Give the pharmacy written notice by certified letter to the
96	102		pharmacy and the pharmacy ’s contracting agent, including
97	103		identification of specific prescription numbers and fill dates to be
98	104		audited, at least fourteen (14) calen dar days prior to conducting
99	105		the audit, including, but not limited to, an on -site audit, a desk
100	106		audit, or a wholesale purchase audit, request for documentation
101	107		related to the dispensing of a prescription drug or any reimbursed
102	108		activity by a pharmacy provid er; provided, however, that wholesale
103	109		purchase audits shall require a minimum of thirty (30) calendar
104	110		days’ written notice. For an on -site audit, the audit date shall be
105	111		the date the on-site audit occurs. For all other audit types, the
106	112		audit date shall be the date the pharmacy provides the documentation
107	113		requested in the audit notice. The pharmacy shall have the
108	114		opportunity to reschedule the audit no more than seven (7) calend ar
109	115		days from the date designated on the original audit notification;
110	116		3. Not interfere with the delivery of pharmacist services to a
111	117		patient and shall utilize every reasonable effort to minimize
112	118		inconvenience and disruption to pharmacy operations during the audit
113	119		process;
114		-	4. Conduct any audit involving clinical or professional
115		-	judgment by means of or in consultation with a licensed pharmacist;
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117		-	ENGR. S. B. NO. 789 Page 3 1
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	147	+	4. Conduct any audit involving clinical or professional
	148	+	judgment by means of or in consultation with a licensed pharmacist;
142	149		5. Not consider as fraud any clerical or record -keeping error,
143	150		such as a typographical error, scrivener ’s error or computer error,
144	151		including, but not limited to, a miscalculated day supply,
145	152		incorrectly billed prescription written date or prescription origin
146	153		code, and such errors shall not be subject to recoupment. The
147	154		pharmacy shall have the right to submit amended claims
148	155		electronically to correct clerical or record -keeping errors in lieu
149	156		of recoupment. To the extent that an audit results in the
150	157		identification of any clerical or record -keeping errors such as
151	158		typographical errors, scrivener ’s errors or computer error s in a
152	159		required document or record, the pharmacy shall not be subject to
153	160		recoupment of funds by the pharmacy benefits manager unless the
154	161		pharmacy benefits manager can provide proof of intent to commit
155	162		fraud. A person shall not be subject to criminal penalties for
156	163		errors provided for in this paragraph without proof of intent to
157	164		commit fraud;
158	165		6. Permit a pharmacy to use the records of a hospital,
159	166		physician, or other authorized practitioner of the healing arts for
160	167		drugs or medicinal supplies written or trans mitted by any means of
161	168		communication for purposes of validating the pharmacy rec ord with
162	169		respect to orders or refills of a legend or narcotic drug;
163		-	7. Permit a pharmacy to use drug purchase records without
164		-	limitation of date or sourc e to validate the dispensing of a
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	197	+	7. Permit a pharmacy to use drug purchase records without
	198	+	limitation of date or source to validate the dispensing of a
191	199		prescription drug or a controlled dangerous substance, provided the
192	200		drug purchase was done in accordance with state or federal law;
193	201		8. Not include the dispensing fee amount or the actual invoice
194	202		cost of the prescription dispensed in a finding of an audit
195	203		recoupment unless a prescription was not actually dispensed or a
196	204		physician denied authorization of a dispensing order;
197	205		8. 9. Audit each pharmacy under identical standards, regularity
198	206		and parameters as other similarly situated pharmacies and all
199	207		pharmacies owned or managed by the pharmacy benefits manager
200	208		conducting or having conducted the audit;
201	209		9. 10. Not exceed one (1) year from the date the claim was
202	210		submitted to or adjudicated by a managed care company, nonprofit
203	211		hospital or medical servic e organization, insurance company, third -
204	212		party payor, pharmacy benefits manager, a health program
205	213		administered by a department of this state, or any entity that
206	214		represents the companies, groups, or departments for the period
207	215		covered by an audit;
208	216		10. 11. Not schedule or initiate an audit during the first
209	217		seven (7) calendar days of any month unless otherwise consented to
210	218		by the pharmacy;
211	219		11. 12. Disclose to any plan sponsor whose claims were included
212	220		in the audit any money recouped in the audit;
213		-	12. 13. Not require pharmacists to break open packaging labeled
214		-	“for single-patient-use only”. Packaging labeled “for single-
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	248	+	12. 13. Not require pharmacists to break open packaging labeled
	249	+	“for single-patient-use only”. Packaging labeled “for single-
241	250		patient-use only” shall be deemed to be the smallest package size
242	251		available; and
243	252		13. 14. Upon recoupment of funds from a pharmacy, refund first
244	253		to the patient the portion of the recovered funds that were
245	254		originally paid by the patient, provided such funds were part of the
246	255		recoupment.
247	256		B. 1. Any entity that conducts wholesale purchase review
248	257		during an audit of a pharmacist or pharmacy shall n ot require the
249	258		pharmacist or pharmacy to provide a full dispensing report.
250	259		Wholesaler invoice reviews shall be limited to verification of
251	260		purchase inventory specific to the pharmacy claims paid by the
252	261		health benefits plan or pharmacy benefits manager conducting the
253	262		audit without limitation to date or source of purchase .
254	263		2. Any entity conducting an audit shall not identify or label a
255	264		prescription claim as an audit discrepancy when:
256	265		a. the National Drug Code for the dispensed drug is in a
257	266		quantity that is a subunit or multiple of the drug
258	267		purchased by the pharmacist or pharmacy as supp orted
259	268		by a wholesale invoice,
260	269		b. the pharmacist or pharmacy dispensed the correct
261	270		quantity of the drug according to the prescription,
262	271		and
263		-	c. the drug dispensed by the pharmacist or pharmacy
264		-	shares all but the last two digits of the National
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266		-	ENGR. S. B. NO. 789 Page 6 1
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	299	+	c. the drug dispensed by the pharmacist or pharmacy
	300	+	shares all but the last two digits of the National
291	301		Drug Code of the drug reflected on the supplier
292	302		invoice.
293	303		3. An entity conducting an audit shall accept as evidence,
294	304		without limitation on date or source of purchase subject to
295	305		validation, to support the validity of a pharmacy claim related to a
296	306		dispensed drug:
297	307		a. redacted copies of supplier invoices in the
298	308		pharmacist’s or pharmacy’s possession, or
299	309		b. invoices and any supporting documents from any
300	310		supplier as authorized by federal or state law to
301	311		transfer ownership of the drug acquired by the
302	312		pharmacist or pharmacy.
303	313		4. An entity conducting an audit shall provide, no later than
304	314		five (5) calendar days after the date of a request by the pharmacist
305	315		or pharmacy, all supporting documents the pharmac ist’s or pharmacy’s
306	316		purchase suppliers provided to the health benefits plan issu er or
307	317		pharmacy benefits manager.
308	318		C. A pharmacy shall be allowed to provide the pharmacy ’s
309	319		computerized patterned medical records or the records of a hospital,
310	320		physician, or other authorized practitioner of the healing arts for
311	321		drugs or medicinal supplies written or transmitted by any means of
312		-	communication for purposes of supporting the pharmacy record with
313		-	respect to orders or refills of a legend or narco tic drug.
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	349	+	communication for purposes of supporting the pharmacy record with
	350	+	respect to orders or refills of a legend or narcotic drug.
340	351		D. The entity conducting the audit shall not audit more than
341	352		fifty prescriptions, with spec ific date of service, per calendar
342	353		year. The annual limit to the number of prescription claims audited
343	354		shall be inclusive of all audits, including any prescription -related
344	355		documentation requests from the health insurer, pharmacy benefits
345	356		manager or any third-party company conducting audits on behalf of
346	357		any health insurer or pharmacy benefits manager during a calendar
347	358		year.
348	359		E. If paper copies of records are requested by the ent ity
349	360		conducting the audit, the entity shall pay twenty -five cents ($0.25)
350	361		per page to cover the costs incurred by the pharmacy. The entity
351	362		conducting the audit shall provide the pharmacy with accurate
352	363		instructions, including any required form for obtaining
353	364		reimbursement for the copied records.
354	365		F. The entity conducting the audit shall :
355	366		1. Deliver a preliminary audit findings report to the pharmacy
356	367		and the pharmacy’s contracting agent within forty -five (45) calendar
357	368		days of conducting the audit;
358	369		2. Allow the pharmacy at least ninety (90) calendar days
359	370		following receipt of the prelimin ary audit findings report in which
360	371		to produce documentation to address any discrepancy found during the
361		-	audit; provided, however, a pharmacy may request a n extension, not
362		-	to exceed an additional forty -five (45) calendar days;
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364		-	ENGR. S. B. NO. 789 Page 8 1
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	399	+	audit; provided, however, a pharmacy may request an extension, not
	400	+	to exceed an additional forty -five (45) calendar days;
389	401		3. Deliver a final audit find ings report to the pharmacy and
390	402		the pharmacy’s contracting agent signed by the auditor within ten
391	403		(10) calendar days after receipt of additional documentation
392	404		provided by the pharmacy, as provided for in Section 356.3 of this
393	405		title;
394	406		4. Allow the pharmacy to reverse and resubmit claims
395	407		electronically within thirty (30) calendar days of receipt of the
396	408		final audit report in lieu of the auditing entity recouping
397	409		discrepant claim amounts from the pharmacy;
398	410		5. Not recoup any disputed funds until after final dis position
399	411		of the audit findings, including the appeals process as provided for
400	412		in Section 356.3 of this title; and
401	413		6. Not accrue interest during the audit and appeal period.
402	414		G. Each entity conducting an audit shall provide a copy of the
403	415		final audit results, and a final audit report upon request, after
404	416		completion of any review process to the plan sponsor.
405	417		H. 1. The full amount of any recoupment on an audit shall be
406	418		refunded to the plan sponsor. Except as provided for in paragraph 2
407	419		of this subsection, a charge or assessment for an audit shall not be
408	420		based, directly or indirectly, on amounts recouped.
409	421		2. This subsection does not prevent the entity conducting the
410	422		audit from charging or assessing the responsible party, directly or
411		-	indirectly, based on amounts recouped if both of the following
412		-	conditions are met:
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	450	+	indirectly, based on amoun ts recouped if both of the following
	451	+	conditions are met:
439	452		a. the plan sponsor and the entity conducting the audit
440	453		have a contract that explicitly states the percentage
441	454		charge or assessment to the plan sponsor, and
442	455		b. a commission to an agent or employee of the entity
443	456		conducting the audit is not based, directly or
444	457		indirectly, on amounts recouped.
445	458		I. Unless superseded by state or federal law, auditors shall
446	459		only have access to pre vious audit reports on a particular pharmacy
447	460		conducted by the auditing entity fo r the same pharmacy benefits
448	461		manager, health plan or insurer. An auditing vendor contracting
449	462		with multiple pharmacy benefits managers or health insurance plans
450	463		shall not use audit reports or other information gained from an
451	464		audit on a pharmacy to conduct another audit for a different
452	465		pharmacy benefits manager or health insurance plan.
453	466		J. Sections A through I of this section shall not apply to any
454	467		audit initiated based on or th at involves fraud, willful
455	468		misrepresentation, or abuse.
456	469		K. If the Attorney Gene ral, after notice and opportunity for
457	470		hearing, finds that the entity conducting the audit failed to follow
458	471		any of the requirements pursuant to the Pharmacy Audit Integrity
459	472		Act, the audit shall be considered null and void. Any monies
460	473		recouped from a null a nd void audit shall be returned to the
461		-	affected pharmacy within fourteen (14) calendar days. Any violation
462	474
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	501	+	affected pharmacy within fourteen (14) calendar days. Any violation
488	502		of this section by a pharmacy benefits manager or auditing entity
489	503		shall be deemed a violation of the Pharmacy Audit Integrity Act.
490	504		SECTION 2. AMENDATORY 59 O.S. 2021, Section 357, as
491	505		amended by Section 4, Chapter 332, O.S.L. 2024 (59 O.S. Supp. 2024,
492	506		Section 357), is amended to read as follows:
493	507		Section 357. A. As used in Sections 357 through 360 of this
494	508		title:
495	509		1. “Covered entity” means a nonprofit hospital or medical
496	510		service organization, for -profit hospital or medical service
497	511		organization, insurer, health benefit plan, health maintenance
498	512		organization, health program administered by the state in the
499	513		capacity of providing he alth coverage, or an employer, labor union,
500	514		or other group of persons that provides health coverage to persons
501	515		in this state. This term does not include a health benefit plan
502	516		that provides coverage only for accidental injury, specified
503	517		disease, hospital indemnity, disability income, or other limited
504	518		benefit health insurance policies and contracts that do not include
505	519		prescription drug coverage;
506	520		2. “Covered individual” means a member, participant, enrollee,
507	521		contract holder or policy holder or beneficiary of a covered entity
508	522		who is provided health coverage by the covered entity. A covered
509	523		individual includes any dependent or other person provided health
510		-	coverage through a policy, contract or plan for a covered
511		-	individual;
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	551	+	coverage through a policy, contract or plan for a covered
	552	+	individual;
538	553		3. “Department” means the Insurance Department;
539	554		4. “Effective rate contracting” means any agreement or
540	555		arrangement between a pharmacy or contracting agent acting on behalf
541	556		of a pharmacy and a pharmacy benefits manager for pharmaceuticals
542	557		based on the effective rate of payment rather than a predetermined
543	558		fixed price or fixed discount percentage;
544	559		5. “Maximum allowable cost ”, “MAC”, or “MAC list” means the
545	560		list of drug products delineating the maximum per -unit reimbursement
546	561		for multiple-source prescription drugs, medical product, or device;
547	562		5. 6. “Multisource drug product reimbursement ” (reimbursement)
548	563		means the total amount paid to a pharmacy inclusive of any reduction
549	564		in payment to the pharmacy, excluding prescr iption dispense fees and
550	565		professional fees;
551	566		6. 7. “Office” means the Office of the Attorney General;
552	567		7. 8. “Pharmacy benefits management ” means a service provided
553	568		to covered entities to facilitate the provision of prescription drug
554	569		benefits to covered individuals within the state, including
555	570		negotiating pricing and other terms with d rug manufacturers and
556	571		providers. Pharmacy benefits management may include any or all of
557	572		the following services:
558		-	a. claims processing, retail network mana gement and
559		-	payment of claims to pharmacies for prescription drugs
560		-	dispensed to covered individuals,
561	573
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	600	+	a. claims processing, retail network management and
	601	+	payment of claims to pharmacies for prescription drugs
	602	+	dispensed to covered individuals,
587	603		b. clinical formulary development and management
588	604		services, or
589	605		c. rebate contracting and administration;
590	606		8. 9. “Pharmacy benefits manager ” or “PBM” means a person,
591	607		business, or other entity that performs pharmacy benefits
592	608		management. The term shall include a person or entity acting on
593	609		behalf of a PBM in a contractual or employment relationship in the
594	610		performance of pharmacy benefits management for a managed care
595	611		company, nonprofit hospital, medical service organization, insurance
596	612		company, third-party payor, or a health program administered by an
597	613		agency or department of this state;
598	614		9. 10. “Plan sponsor” means the employers, insurance companies,
599	615		unions and health maintenance organizations or any other entity
600	616		responsible for establishing, maintaining, or admini stering a health
601	617		benefit plan on behalf of covered individuals; and
602	618		10. 11. “Provider” means a pharmacy licensed by the State Board
603	619		of Pharmacy, or an agent or representative of a pharmacy, including,
604	620		but not limited to, the pharmacy ’s contracting agent, which
605	621		dispenses prescription drugs or devices to covered individuals.
606	622		B. Nothing in the definition of pharmacy benefits management or
607	623		pharmacy benefits manager in the Patient ’s Right to Pharmacy Choice
608		-	Act, Pharmacy Audit Integrity Act, or Sections 357 through 360 of
609		-	this title shall deem an employer a “pharmacy benefits manager ” of
610		-	its own self-funded health benefit plan, except, to the extent
611	624
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	651	+	Act, Pharmacy Audit Integrity Act, or Sections 357 th rough 360 of
	652	+	this title shall deem an employer a “pharmacy benefits manager ” of
	653	+	its own self-funded health benefit plan, except, to the extent
637	654		permitted by applicable law, wher e the employer, without the
638	655		utilization of a third party and unrelated to the em ployer’s own
639	656		pharmacy:
640	657		a. negotiates directly with drug manufacturers,
641	658		b. processes claims on behalf of its members, or
642	659		c. manages its own retail network of pharmacies.
643	660		SECTION 3. AMENDATORY 59 O.S. 2021, Section 360, as
644	661		amended by Section 6, Chapter 332, O.S.L. 2024 (59 O.S. Supp. 2024,
645	662		Section 360), is amended to read as follows:
646	663		Section 360. A. The pharmacy benefits manager shall, with
647	664		respect to contracts between a pharmacy benefits manager and a
648	665		provider, including a pharmac y service administrative organization:
649	666		l. Include in such contracts the specific sources utilized to
650	667		determine the maximum allowable cost (MAC) pricing of the pharmacy,
651	668		update MAC pricing at least every seven (7) calendar days, and
652	669		establish a process for providers to readily access the MAC list
653	670		specific to that provider;
654	671		2. In order to place a drug on the MAC list, ensure that the
655	672		drug is listed as “A” or “B” rated in the most recent version of the
656	673		FDA’s Approved Drug Products with Therapeutic Equivalenc e
657	674		Evaluations, also known as the Orange Book, and the drug is
658		-	generally available for purchase by pharmacies in the state from
659		-	national or regional wholes alers and is not obsolete;
660	675
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	702	+	generally available for purchase by pharmacies in the state from
	703	+	national or regional wholesalers and is not obsolete;
686	704		3. Ensure dispensing fees are not included in the calculation
687	705		of MAC price reimbursement to pharmacy providers;
688	706		4. Provide a reasonable administration appeals procedure to
689	707		allow a provider, a provider ’s representative and a pharmacy service
690	708		administrative organization to contest reimbursement amounts within
691	709		fourteen (14) calend ar days of the final adjusted payment date. The
692	710		pharmacy benefits manager shall not prevent the pharmacy or the
693	711		pharmacy service administrative organization from filing
694	712		reimbursement appeals in an electronic batch format. The pharmacy
695	713		benefits manager must respond to a provider, a provider ’s
696	714		representative and a pharmacy service administrative organization
697	715		who have contested a reimbursement amount through this procedure
698	716		within ten (10) calendar days. The pharmacy benefits manager must
699	717		respond in an electronic batch format to reimbursement appeals filed
700	718		in an electronic batch format. The pharmacy benefits manager shall
701	719		not require a pharmacy or pharmacy services administrative
702	720		organization to log into a system to upload individual claim appeals
703	721		or to download individual appeal responses. If a price update is
704	722		warranted, the pharmacy benefits manager shall make the change in
705	723		the reimbursement amount, permit the dispensing pharma cy to reverse
706	724		and rebill the claim in question, and make the reimbursement amoun t
707	725		change retroactive and effective for all contracted providers; and
708		-	5. If a below-cost reimbursement appeal is denied, the PBM
709		-	shall provide the reason for the denial, including the National Drug
710	726
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	753	+	5. If a below-cost reimbursement appeal is denied, the PBM
	754	+	shall provide the reason for the denial, including the National Drug
736	755		Code (NDC) number from, and the name of, the specific nati onal or
737	756		regional wholesalers doing business in this state where the drug is
738	757		currently in stock and available for purchase by the dispensing
739	758		pharmacy at a price below the PBM ’s reimbursement price. If the NDC
740	759		number provided by the pharmacy benefits manage r is not available
741	760		below the acquisition cost obtained from the pharmaceutical
742	761		wholesaler from whom the dispensing pharmacy purchases the majority
743	762		of the prescription drugs that are dispensed, the pharmacy benefits
744	763		manager shall immediately adjust the reim bursement amount, permit
745	764		the dispensing pharmacy to reverse and rebill the claim in question,
746	765		and make the reimbursement amount adjustment retroactive and
747	766		effective in effect for all contracted providers for future claims
748	767		billed.
749	768		B. The reimbursement appe al requirements in this section shall
750	769		apply to all drugs, medical products, or devices reimbursed
751	770		according to any payment methodology, including, but not limited to:
752	771		1. Average acquisition cost, including the National Average
753	772		Drug Acquisition Cost;
754	773		2. Average manufacturer price;
755	774		3. Average wholesale price;
756	775		4. Brand effective rate or generic effective rate;
757	776		5. Discount indexing;
758		-	6. Federal upper limit s;
759		-	7. Wholesale acquisition cost; and
760	777
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	804	+	6. Federal upper limits;
	805	+	7. Wholesale acquisition cost; and
786	806		8. Any other term that a pharmacy benefits manager or an
787	807		insurer of a health benefit plan may use to establish reimbursement
788	808		rates to a pharmacist or pharmacy for pharmacist services.
789	809		C. The pharmacy benefits manager shall not place a drug on a
790	810		MAC list, unless there are at least two therapeutically equivalent,
791	811		multiple-source drugs, generally available for purchase by
792	812		dispensing retail pharmacies from national or regional wholesalers.
793	813		D. In the event that a drug is placed on the FDA Dru g Shortages
794	814		Database, pharmacy benefits managers shall reimburse claims to
795	815		pharmacies at no less than the wholesale acquisition cost for the
796	816		specific NDC number being dispensed.
797	817		E. The pharmacy benefits manager shall not require
798	818		accreditation or licensing of providers, or any entity licensed or
799	819		regulated by the State Board of Pharmac y, other than by the State
800	820		Board of Pharmacy or federal government entity as a condition for
801	821		participation as a network provider.
802	822		F. A pharmacy or pharmacist may decline to pr ovide the
803	823		pharmacist clinical or dispensing services to a patient or pharmacy
804	824		benefits manager if the pharmacy or pharmacist is to be paid less
805	825		than the pharmacy’s cost for providing the pharmacist clinical or
806	826		dispensing services.
807		-	G. The pharmacy benefits manager shall provide a dedicated
808		-	telephone number, email address and names of the personnel with
809		-	decision-making authority regarding MAC appeals and pricing.
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	854	+	G. The pharmacy benefits manager shall provide a dedicated
	855	+	telephone number, email address and names of the personnel with
	856	+	decision-making authority regarding MAC appeals and pricing.
836	857		H. No pharmacy benefit s manager (PBM) shall lease, rent, or
837	858		otherwise make its provider network available to another pharmacy
838	859		benefits manager. Prohibited activities shall include, but not be
839	860		limited to:
840	861		1. Entering into agreements or contracts that allow another PBM
841	862		to use the provider network; and
842	863		2. Facilitating access to the provider network though any form
843	864		of leasing or renting arrangement.
844	865		I. The PBM shall, with respe ct to contracts between a PBM and a
845	866		provider, including contracts with pharmacy service administrative
846	867		organization, ensure that reimbursement to pharmacies for each drug
847	868		dispensed is no less than one hundred six percent (106%) of the
848	869		National Average Drug Acquisition Cost (NADAC) plus a professional
849	870		fee of Fifteen Dollars ($15.00). The NADAC price shall be the price
850	871		published in effect for the date the drug claim was billed by the
851	872		pharmacy. If a particular drug does not have a published NADAC
852	873		price, the reimbursement shall be one hundred ten percent (110%) of
853	874		the wholesale acquisition cost (WAC) plus a professional fee of
854	875		Fifteen Dollars ($15.00) for generic drugs and one hund red (100%)
855	876		percent of the WAC plus a professional fee of Fifteen Dollars
856	877		($15.00) for brand-name drugs. The professional fee shall
857		-	automatically increase on January 1 of each year at a percentage
858		-	equal to the inflation rate measured by the Consumer Price Index for
859		-	the previous twelve-month period.
860	878
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	905	+	automatically increase on January 1 of each year at a percentage
	906	+	equal to the inflation rate measured by the Consumer Price Index for
	907	+	the previous twelve-month period.
886	908		J. 1. Effective rate contracting i s hereby prohibited in all
887	909		agreements between pharmacies or contracting agents acting on behalf
888	910		of a pharmacy and a PBM or third -party payers. No PBM or third -
889	911		party payer shall enter into any contract that establishes payment
890	912		for services or medications b ased on an effective rate of
891	913		reimbursement.
892	914		2. Any PBM or third-party payer found to be in violation of
893	915		this section shall be subject to penalties, including , but not
894	916		limited to, fines, revocation of licensure, or other disciplinary
895	917		actions.
896	918		K. The provisions of this section shall not be waived, voided,
897	919		or nullified by contract.
898	920		SECTION 4. This act shall become effective November 1, 2025.
899		-	Passed the Senate the 27th day of March, 2025.
900		-
901		-
902		-
903		-	Presiding Officer of the Senate
904		-
905		-
906		-	Passed the House of Representatives the ____ day of __________,
907		-	2025.
908		-
909		-
910		-
911		-	Presiding Officer of the House
912		-	of Representatives
913		-
	921	+	COMMITTEE REPORT BY: COMMITTEE ON BUSINESS AND INSURANCE
	922	+	February 20, 2025 - DO PASS