Pharmacy Benefit Manager Practices

The bill:

• Allows a pharmacy benefit manager (PBM) to earn income derived from the assessment of a flat-dollar service fee;
• Prohibits a PBM from earning income based on the cost of a prescription drug;
• Prohibits a PBM from designing a formulary to favor a certain branded pharmaceutical or biologic;
• Sets the amount that a PBM shall reimburse an unaffiliated pharmacy or a PBM-affiliated retail, mail order, or specialty pharmacy for a prescription drug;
• Requires a PBM to credit income derived from a source other than a flat-dollar service fee to a health insurance carrier (carrier) or a self-funded health benefit plan; and
• Requires a PBM to make certain documents and data available to a carrier, a self-funded plan, or the commissioner of insurance upon request.
  (Note: This summary applies to this bill as introduced.)