SB 325 - Sater, David
Delineates procedures to be used by pharmacy benefit managers with regards to maximum allowable cost lists
Bill Details
Sponsor
LR Number
1500S.01I
Title
SB 325
House Handler
N/A
Journal Page
N/A
Effective Date
August 28, 2015
Committee
Current Status
Voted Do Pass S Veterans' Affairs and Health Committee
Quick Links
Amendments
No amendments available
CURRENT BILL SUMMARY
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).
SARAH HASKINS