SB 325 - This act delineates the procedures to be used by pharmacy benefit managers (PBMs) as to practices used with contracted pharmacies participating in a PBM network. This act adds a definition of "maximum allowable cost list" or "MAC list" to mean a listing of drugs used by a PBM setting the maximum allowable cost on which reimbursement to a pharmacy or pharmacist may be based.
This act provides that for every drug for which the PBM establishes a maximum allowable cost to determine the drug product reimbursement, the PBM shall:
- Make available to a contracted pharmacy the drug products subject to the MAC list and the actual maximum allowable cost for each drug;
- Provide to each contracted pharmacy subject to the MAC list access to current date of service MAC list;
- Provide a specified appeal procedure to allow pharmacies to challenge maximum allowable costs for a specific drug(s).
The act also delineates the specified types of disclosures PBMs shall make to the plan sponsor. Any PBM who fails to comply with the provisions of this act shall be subject to specified penalties.
This act is identical to HB 780 (2015), substantially similar to SB 895 (2014), and similar to provisions in HCS/SCS/SB 38 (2015), SS/SB 451 (2015), HCS/SS/SB 457 (2015), and HCS/SB 458 (2015).