SCS/SB 908 - The act requires each contract between a pharmacy benefit manager (PBM) and a pharmacy or pharmacy's contracting representative to include sources utilized to determine maximum allowable cost (MAC) and update such pricing information at least every seven days. A PBM shall maintain a procedure to eliminate products from the MAC list of drugs or modify MAC pricing within seven days if the drugs do not meet the standards as provided in the act.
A PBM shall reimburse pharmacies for drugs subject to MAC pricing based upon pricing information which has been updated within seven days. A drug shall not be placed on a MAC list unless there are at least two therapeutically equivalent multi-source generic drugs, or at least one generic drug available from at least one manufacturer and is generally available for purchase from national or regional wholesalers.
All contracts shall include a process to internally appeal, investigate, and resolve disputes regarding MAC pricing as provided in the act. Appeals shall be upheld if the pharmacy being reimbursed for the drug on the MAC list was not reimbursed according to the act or the drug does not meet the requirements for being placed on the MAC list.
This act is substantially similar to provisions in CCS#2/HCS/SS/SB 608 (2016), CCS/HCS/SB 635 (2016), CCS/HCS/SS/SCS/SBs 865 & 866 (2016), HCS/HB 2045 (2016), HB 2316 (2016), HCS/SB 458 (2015), and similar to SB 325 (2015) and SB 895 (2014).