AT A GLANCE

This bill expands eligibility for post-arrest or post-conviction vacatur and record sealing for human-trafficking, intimate-partner-violence, and sexual-violence victims by allowing vacatur of any offense except murder.

AT A GLANCE

This bill requires PBM contracts with Massachusetts pharmacies to set ingredient cost criteria and dispensing fees at least equal to State Medicaid payments and prohibits retroactive rate reductions, pharmacy steering, and brand incentives when generics are available.

AT A GLANCE

This bill requires the Massachusetts Health Policy Commission’s Office of Health Resource Planning to assess statewide pharmacy supply and “pharmacy deserts” and report findings by September 1, 2026.

AT A GLANCE

This bill makes home education a natural right for parents, allowing an optional declaration only to access public school programs under RSA 193:1-c or upon withdrawal from public school.

AT A GLANCE

This bill requires the Health Policy Commission to hold annual public hearings by October 1 comparing actual aggregate primary care expenditures to the aggregate primary care expenditure target and examining related drivers.

AT A GLANCE

This bill requires New Hampshire health plans to give covered persons written, 14-point formulary-deletion notice at least 60 days before removing drugs and to maintain specified prescription-drug records for commissioner review.

AT A GLANCE

This bill prohibits health plan issuers, including pharmacy benefit managers and third-party administrators, from restricting pharmacies, pharmacists, or personally furnishing prescribers from offering prescription transparency and access services.

AT A GLANCE

This bill requires the Department of Managed Health Care to maintain a public website listing each licensed PBM’s key license details, but makes the website requirement operative only after additional appropriations.

AT A GLANCE

This bill requires any person soliciting pharmacy benefit plans in Ohio or providing PBM services under covered agreements to hold a PBM license by July 1, 2027.

AT A GLANCE

This bill requires PEIA to issue a competitive pharmacy cost containment vendor solicitation by July 1, 2026, including separate contracting and itemized monthly savings reporting, while engaging prescribing providers without mandating clinical changes.

AT A GLANCE

This bill limits pharmacy audits to no more than once every 12 months and requires 14-day advance notice and pharmacist-conducted judgment-based audits before on-site review of contracted pharmacies.

AT A GLANCE

This bill requires pharmacy benefit managers to obtain a certificate of authority from the Rhode Island health insurance commissioner to operate or hold themselves out as PBMs.

AT A GLANCE

This bill requires pharmacy benefit managers to maintain and follow a reasonable appeals process for multi-source generic pricing disputes, including submitting determinations within 15 days.

AT A GLANCE

This bill requires pharmacy benefit managers to obtain a certificate of authority from Rhode Island’s Health Insurance Commissioner before acting, offering services, or holding themselves out as PBMs.

AT A GLANCE

This bill requires insurers to demonstrate to the director their willingness and potential ability to ensure pharmacy services meet availability, accessibility, adequate personnel and facilities, and continuity requirements.

AT A GLANCE

This bill requires the Health Policy Commission to establish and publish statewide aggregate primary care expenditure targets for 2027, 2028, and 2029, and to not reduce later targets below 12%.

AT A GLANCE

This bill requires the Health Policy Commission to enforce performance improvement plans and civil penalties against health care entities that CHIA identifies as failing primary care expenditure targets.

AT A GLANCE

This bill requires pharmacy benefits managers operating in Massachusetts to obtain a license from the Commissioner of Insurance before providing pharmacy benefits management services.

AT A GLANCE

This bill establishes a pharmacy benefit manager duty of care to enrollees, health benefit plans, and providers, and requires the Commissioner of Insurance to regulate, enforce violations, and impose penalties.

AT A GLANCE

This bill establishes pharmacy benefit manager duties to perform pharmacy benefit management services in the best interests of enrollees, health benefit plans, and providers, under specified transparency and conflict-disclosure standards.

AT A GLANCE

This bill requires a pharmacy benefits manager to update its maximum allowable cost list within seven calendar days after specified cost changes and provide affected pharmacies access to the list.

AT A GLANCE

This bill requires pharmacy benefits managers and covered entities to update each maximum allowable cost list at least every three business days and use the updated MACs to calculate payments within two business days.

AT A GLANCE

This bill prohibits pharmacy benefit managers in Massachusetts from earning income from pharmacy benefit management services except through a stated, contract-listed pharmacy benefit management fee not tied to drug prices or savings.

AT A GLANCE

This bill prohibits pharmacy benefit managers from transferring or receiving patient or prescriber-identifiable prescription records with an affiliated provider for a commercial purpose, with specified exceptions.

AT A GLANCE

This bill prohibits a pharmacy benefit manager from acquiring or holding any retail pharmacy permit interest in Arizona and requires the State Board of Pharmacy to revoke or not renew violating permits.

AT A GLANCE

This bill requires pharmacy benefit managers to reimburse local pharmacies using a NADAC-based reimbursement formula with specified adjustment and dispensing-fee limits starting January 1, 2026.

AT A GLANCE

This bill requires pharmacy benefit managers to act solely for the benefit of health plans and enrollees and bars conduct that increases drug costs or interferes with access except as plan design requires.

AT A GLANCE

This bill requires PBMs to pay participating pharmacies at least the NADAC rate or, if unavailable, the pharmacy acquisition cost rate, plus minimum dispensing fees, and bars payment below acquisition cost.

AT A GLANCE

This bill requires PBMs to pay participating pharmacies at least the NADAC rate or, if unavailable, the pharmacy acquisition cost rate plus a professional dispensing fee, and it applies to contracts beginning January 1, 2027.

AT A GLANCE

This bill bars pharmacy benefit managers from acquiring, holding, or controlling any ownership or beneficial interest in a pharmacy license or holder starting January 1, 2027.

This legislation introduces comprehensive regulations affecting pharmacies and pharmacy benefit managers (PBMs) within Tennessee. It restricts PBMs from acquiring, holding, or exercising control over pharmacy licenses or entities through ownership, contractual, or operational arrangements starting January 1, 2027. These measures aim to reduce conflicts of interest, enhance transparency, and ensure patient access, particularly in rural and underserved areas. Pharmacies are required to disclose ownership and control information annually, and the law emphasizes maintaining independent pharmacy operations free from PBM influence.

The legislation also provides exemptions for hospital or health-system pharmacies that serve only their own patients or employees. Additionally, it establishes protections for independently owned or unaffiliated pharmacies offering mail-order, specialty, or delivery services. Impacted pharmacies affiliated with PBMs may continue operations until the end of 2026 if they demonstrate active efforts to sell to unaffiliated entities, with potential extensions upon proof of progress.

Enforcement provisions include oversight mechanisms, with the Tennessee Board of Pharmacy tasked with assessing potential violations and notifying licensees. Affected pharmacies must inform patients and healthcare providers of any changes by November 1, 2026, indicating that they may no longer dispense medications after that date. The law also introduces a limited-use pharmacy license for rare or FDA-designated drugs, which is subject to annual review and cannot be transferred to PBMs or their affiliates.

Overall, the legislation seeks to strengthen the integrity of Tennessee’s healthcare delivery system by separating financial interests from clinical decision-making, potentially reducing drug costs and improving access. It aims to promote fair competition among pharmacies and PBMs, ultimately benefiting consumers through increased transparency and reduced conflicts of interest.

AT A GLANCE

This bill requires written audit requests for registered pharmacists and pharmacies to include a signed receipt acknowledgment before any prescription record audit includes identifying prescription information in notices.

AT A GLANCE

This bill requires audit entities to give pharmacies 14 days’ advance written notice of on-site pharmacy audits, including the prescription-number range, before starting audits under Rhode Island law.

AT A GLANCE

This bill makes specified pharmacy benefits manager conduct unfair and deceptive and a method of unfair competition under Rhode Island law when the conduct involves spread or effective rate pricing, patient steering, or other prohibited acts.

AT A GLANCE

This bill prohibits persons from simultaneously owning specified health care entity combinations in Ohio, requiring divestment within one year or cessation of Ohio services within two years for existing violators.

AT A GLANCE

This bill requires pharmacy benefits managers to certify annual compliance with the Commissioner by an executive officer, signed each year, and makes PBM fees administrative costs in carrier rate filings.

AT A GLANCE

This bill bars pharmacy benefits managers, in contracts entered into or modified on or after August 28, 2018, from requiring a covered person at point of sale to pay more than the lesser of the copay or the cash price.

AT A GLANCE

This bill requires pharmacy record audits to include at least 14 days’ written notice and limits initial on-site audit cycles to two times per calendar year unless probable fraud is suspected.

AT A GLANCE

This bill requires PBMs to use NADAC-based pharmacy reimbursement by January 1, 2026, and to provide pharmacists an appeal process with corrective payments when claims fall below acquisition cost.

AT A GLANCE

This bill requires a health carrier and any pharmacy benefits manager to enter and retain a written agreement, with semiannual audits, for PBMs administering New Hampshire benefits to more than 100 covered lives.

AT A GLANCE

This bill requires pharmacy benefits managers to submit plain-language, machine-readable reports every six months to New Jersey plan sponsors and the Department for specified drug claims and related compensation.

AT A GLANCE

This bill prohibits pharmacy benefits managers from receiving commission-based or non–bona fide service-fee compensation for administering or managing prescription drug benefits for a carrier, requiring flat, fair-market-value itemized services.

AT A GLANCE

This bill requires pharmacy benefits managers to include required compliance and information-obligation clauses in PBM–plan sponsor contracts and to submit plain-language, machine-readable claims and spending reports at least every six months.

The bill establishes minimum participation and contract-standard requirements for pharmacy networks under New Jersey health benefits plans administered or managed by pharmacy benefits managers (PBMs). It requires a covered health benefits plan to allow any pharmacy that meets the plan’s “standard contract terms and conditions” to participate as a network pharmacy.

It also requires that PBM plan contract terms and conditions be “reasonable and relevant,” as determined by the Commissioner of Banking and Insurance. In making that determination, the commissioner must review (among other items) the current terms and conditions in network pharmacy contracts and whether the reimbursement and dispensing fees paid by the health benefits plans are sufficient to cover ingredient and operational costs.

The Commissioner of Banking and Insurance is authorized to adopt rules and regulations under the Administrative Procedure Act as necessary to implement the bill.

The bill takes effect on the first day of the 13th month after enactment and applies to contracts between a health benefits plan and a PBM that are initiated or renewed on or after the enactment date.

AT A GLANCE

This bill prohibits pharmacy benefit managers from using spread pricing and bars them from entering, extending, or renewing pharmacy benefits management contracts unless they remit 100% of related remuneration to carriers or purchasers.

AT A GLANCE

This bill prohibits PBMs from using spread pricing or entering or renewing covered PBM contracts unless the contracts require 100% remittance of related remuneration to carriers or purchasers.

AT A GLANCE

This bill limits pharmacy benefits managers to recoupment only from corrected, adjudicated amounts in narrowly scoped audits, and bars recoupment based on extrapolation while requiring at least 14 days’ written notice.

AT A GLANCE

This bill bars pharmacy benefits managers from acquiring any direct or indirect interest in, or holding any direct or indirect permit to operate, a pharmacy practice site under the New Jersey Pharmacy Practice Act.

AT A GLANCE

This bill prohibits pharmacy benefits managers and pharmacy services administrative organizations from structuring compensation as a commission or as any fee other than a bona fide service fee when administering pharmacy benefits.

The bill establishes standards governing contracts between pharmacy benefits managers (PBMs) and health benefits plans that administer or manage prescription drug or pharmacy services.

A health benefits plan with PBM administration or management must allow any pharmacy that meets the plan’s “standard contract terms and conditions” to participate as a network pharmacy. Contract terms and conditions must be “reasonable and relevant,” as determined by the Commissioner of Banking and Insurance, with the commissioner required to review (among other items) (1) current terms and conditions in network pharmacy contracts and (2) the reimbursement and dispensing fees paid by the health benefits plan, including whether those payments are sufficient to cover ingredient and operational costs.

The Commissioner of Banking and Insurance is authorized to adopt rules and regulations under the Administrative Procedure Act as necessary to implement the bill.

The bill takes effect on the first day of the thirteenth month following enactment and applies to PBM-related contracts between a health benefits plan and a PBM that are initiated or renewed on or after the enactment date.

AT A GLANCE

This bill requires each chain or community pharmacy to apply to New York’s Department for designation as either a chain or community pharmacy, renewing every three years with a $500 fee.

AT A GLANCE

This bill requires payors to pay providers full amounts for clean claims within 30 calendar days after receipt and mandates itemized claim-level accounting for each remittance.

AT A GLANCE

This bill requires pharmacy benefits manager contracts with the Oklahoma Employees Insurance Plan to pass all rebates through to the Plan and make them fully audit-accessible.

AT A GLANCE

This bill requires pharmacy benefit managers to update MAC pricing at least every seven calendar days using specified sources and to exclude dispensing fees from MAC reimbursement calculations for contracted pharmacies.

AT A GLANCE

This bill requires PBMs and insurers to disclose pharmacy-related affiliated-entity structures and quarter-by-quarter claims data to the commissioner and attorney general.

AT A GLANCE

This bill requires pharmacy benefit managers to maintain a reasonably adequate, accessible in-state pharmacy network and bars steering by imposing a 10% surcharge on providers engaging in such conduct.

AT A GLANCE

This bill prohibits pharmacy benefit managers from using retroactive discount or “effective rate” methods that reduce ingredient payments and requires them to include ingredient costs and dispensing fees no less than Massachusetts Medicaid.

The document outlines amendments to Section 38-71-2240 of the South Carolina Code of Laws, focusing on the pharmacy benefits management industry. The amendments mandate that pharmacy benefits managers provide unobstructed access to their Maximum Allowable Cost Lists for patients, consumers, and network pharmacy providers.

Key provisions include a requirement for pharmacy benefits managers to update their Maximum Allowable Cost Lists at least once every seven calendar days. Additionally, a process will be established for network pharmacy providers and pharmacies to access these updates.

The amendments also introduce a reasonable internal appeal procedure for pharmacies to contest reimbursement rates that fall below their acquisition costs for drugs. Furthermore, there will be an external review process for denied internal appeals conducted by an independent review organization.

These changes are expected to enhance transparency within the pharmacy benefits management system and may influence reimbursement rates for pharmacies. The act will take effect upon approval by the Governor.

The document outlines amendments to the South Carolina Code of Laws that affect pharmacies and pharmacy benefits managers (PBMs). One significant change requires all pharmacies in South Carolina to cooperate with federal and state acquisition cost surveys, specifically the National Average Drug Acquisition Cost (NADAC) survey.

Additionally, the amendments establish new reimbursement guidelines for PBMs. They are required to reimburse pharmacies and pharmacists for prescription drugs and pharmacy services at or above the NADAC at the time of dispensing, along with a professional dispensing fee that must meet or exceed the current South Carolina Medicaid professional dispensing fee. In cases where NADAC is unavailable, the minimum reimbursement must be based on the Wholesale Acquisition Cost (WAC) plus the same professional dispensing fee.

Furthermore, a formal complaint process is introduced for pharmacies or pharmacists who believe they have been reimbursed below the mandated minimum. They can file a complaint with the Department of Insurance, which is obligated to review and make a determination within thirty days. If the complaint is upheld, the PBM must compensate the pharmacy or pharmacist for the underpayment and adjust reimbursements for similarly situated pharmacies.

Overall, this legislation aims to enhance financial accountability for PBMs and establish stricter reimbursement standards within the pharmacy industry.

AT A GLANCE

This bill prohibits pharmacy benefit managers from steering covered persons away from qualified medically integrated pharmacies affiliated with their treating specialty providers, including by denying network participation or imposing retaliatory policies.

AT A GLANCE

This bill requires pharmacy benefits managers to update MAC pricing at least every seven days, provide provider-specific MAC lists, and honor reimbursement appeals within 10 days.

The bill makes changes to Tennessee’s sales tax exemption rules for certain prescription drugs and related services. It requires that (i) the existing exclusion of prescription drugs and patent medicines not otherwise exempt under Tennessee Code Annotated (TCA) § 67-4-712(g)(1) be narrowed/updated by changing the cross-reference text in TCA § 67-4-708(2)(D), and (ii) a new exemption be added to TCA § 67-4-712 for specified prescription drug receipts.

Specifically, receipts from the sale of prescription drugs or medicines are exempt from the tax imposed under TCA Title 67, Chapter 4, Part 7 when the drug’s cost for a 30-day equivalent supply exceeds the Medicare Part D specialty tier cost threshold for 2025 plan years. The threshold is determined by the federal Centers for Medicare and Medicaid Services (CMS) pursuant to 42 CFR § 423.104(d)(2)(iv)(A). The exemption also covers services necessary for proper preparation, storage, handling, administration, patient education, or post-sale monitoring of drugs or medicines that qualify for the exemption under the new subsection.

The act takes effect July 1, 2025.

AT A GLANCE

This bill requires pharmacy benefit managers to immediately notify the Director of material ownership or control changes and imposes $100-per-day penalties for late renewal submissions.

The bill authorizes the Alabama Commissioner of Insurance to staff the Department of Insurance’s Pharmacy Benefits Manager Division with up to two additional employees in the “exempt service,” meaning the employees are not subject to the state Merit System. It specifies that these two exempt personnel positions are in addition to any other exempt positions already authorized by law for the department, and directs that the compensation for these employees be set by the commissioner (Section 1).

It sets an effective date of June 1, 2026 (Section 2).

No other substantive provisions appear in the text provided beyond these employment-authorizing and effective-date requirements.

AT A GLANCE

This bill makes pharmacy benefit managers’ specified conduct, including spread or effective rate pricing and patient steering tied to control or inducements, unlawful as unfair and deceptive trade practices in Rhode Island.

AT A GLANCE

This bill requires auditing entities to provide pharmacies 14 days’ advance written notice before audits, including the prescription-range involved, and to establish a pharmacy appeal process for unfavorable preliminary reports.

AT A GLANCE

This bill prohibits pharmacy benefit managers and carriers from using misleading promotions, charging unreasonable claim-adjudication fees, or reimbursing pharmacies less than affiliates for the same services.

AT A GLANCE

This bill requires pharmacy benefit managers to allow covered persons who face mail-order delivery delays or unusable drug conditions to receive network-pharmacy dispensing capped at one copayment, coinsurance, or other out-of-pocket amount.

AT A GLANCE

This bill requires pharmacy benefit managers and managed care organizations to reimburse community pharmacies at or above the new “fair pharmacy reimbursement” standard, and it prohibits fees or reductions that would cause below-standard net reimbursement.

AT A GLANCE

This bill requires PBMs to file aggregated rebate and pricing reports with the Kansas Insurance Commissioner and limits their reimbursement practices to benchmarked amounts and capped patient cost shares.

AT A GLANCE

This bill requires PBMs and MCOs to reimburse community pharmacies at least NADAC (or WAC if NADAC is unavailable) plus a biennially adjusted professional dispensing fee.

AT A GLANCE

This bill prohibits PBMs and managed care plans from reimbursing Louisiana pharmacies below specified NADAC-based minimums and bars reimbursement calculations using spread pricing, steering, or effective rate pricing.

AT A GLANCE

This bill requires pharmacy benefit managers to register with the Kansas Insurance Commissioner before acting and prohibits them from collecting cost-sharing above submitted charges.

The bill establishes new state drug-pricing restrictions by creating R.S. 22:1867.1 (“Drug pricing”). It requires that a pharmaceutical manufacturer may not offer any drug for use in an Office of Group Benefits (OGB) insurance plan or any other state sponsored insurance plan at a price higher than the price Medicare pays for the same drug.

It also bars insurers, pharmacy benefit managers (PBMs), and any person acting on behalf of a PBM from providing reimbursement for any name brand drug, biosimilar, or generic drug for an OGB insurance plan or other state sponsored insurance plan if the reimbursement would be for an amount less than the price Medicare pays for the same drug.

The commissioner is directed to enforce the new restrictions and to promulgate any necessary rules and regulations to carry them out.

The law takes effect on January 1, 2027.

AT A GLANCE

This bill requires the commissioner to levy a $25,000 fine per pharmacy-benefits violation with no aggregate maximum, and to suspend or revoke the insurer’s certificate if the violation isn’t corrected within 30 days of notice.

The commissioner of commerce and insurance is required to publish, using existing resources, a report due on or before October 1, 2026 containing data on violations of Tennessee Code Annotated § 56-7-3124 reported to the commissioner as alleged to have occurred during the fiscal year ending June 30, 2026. The report must include (1) the total number of violations reported, (2) the commissioner’s findings from investigations into the alleged violations, and (3) the penalties imposed by the commissioner on pharmacy benefits managers found to have violated § 56-7-3124. A copy must be submitted to the chief clerk of the senate, the chief clerk of the house of representatives, and the legislative librarian, and the report may be published and delivered electronically.

The act takes effect upon becoming a law, with the public welfare requiring it.

AT A GLANCE

This bill requires pharmacy benefit managers to reimburse under-reimbursed dispensing fees for Louisiana nonaffiliated pharmacies and pharmacists without charging any costs to plans, members, pharmacies, or pharmacists.

AT A GLANCE

This bill requires pharmacy benefit managers to update Medicaid MAC pricing at least every seven calendar days and to allow providers to electronically appeal reimbursement within 14 days of final adjusted payment.

AT A GLANCE

This bill requires carriers and pharmacy benefits managers to use pass-through pricing in Virginia and to prohibit spread pricing.

AT A GLANCE

This bill requires pharmacy benefit managers to update maximum allowable cost pricing at least every seven days using specified sources and to provide updated MAC information to contracting pharmacies upon request.

AT A GLANCE

This bill requires PBMs to reimburse pharmacies and pharmacists at least NADAC plus a $10.49 professional dispensing fee (or WAC plus $10.49 if NADAC is unavailable) and voids conflicting contract terms.

AT A GLANCE

This bill transfers PBM and PSAO regulatory and enforcement authority to the Commissioner of Insurance beginning July 1, 2026.

AT A GLANCE

This bill prohibits pharmacy benefit managers from reimbursing non-affiliated pharmacies or pharmacists less than net effective reimbursement for the same drug or service, including all fees and incentives.

AT A GLANCE

This bill requires PBM-participating pharmacy contracts to include an administrative appeal procedure allowing pharmacies to file consolidated appeals within 30 business days and PBMs to respond within 30 business days.

AT A GLANCE

This bill prohibits pharmacy benefit managers from reimbursing non-affiliated pharmacies or pharmacists at lower net rates than affiliated providers for the same drug or service, and bars evasion of these requirements.

AT A GLANCE

This bill bars PSAOs, pharmacy switch companies, and rebate aggregators from operating in New York after specified deadlines unless each first registers and files required electronic disclosures with the Superintendent.

The recent legislative changes significantly impact the regulation of pharmacy benefit managers (PBMs) in Wisconsin, focusing on enhancing transparency, fairness, and accessibility in pharmaceutical pricing and reimbursement practices. Key provisions require PBMs to pay pharmacies a professional dispensing fee that matches state medical assistance rates and prohibit them from imposing fees that would require remuneration from pharmacies. Additionally, PBMs must allow any licensed pharmacy to participate in their networks under the same terms and cannot charge different copayments based on network participation.

The legislation mandates that PBMs maintain and provide access to maximum allowable cost (MAC) lists, which must be updated promptly in response to price changes. Pharmacies are granted the right to appeal MAC determinations that fall below their acquisition costs, with PBMs required to resolve these appeals within a specified timeframe. Furthermore, PBMs are prohibited from discriminating against 340B covered entities and must ensure that all pharmacies in a preferred network are reimbursed at the same rates.

Auditing practices are also addressed, with requirements for uniformity in audits across similar pharmacies and restrictions on recouping reimbursements for errors that do not result in financial harm. PBMs must deliver final audit reports within a designated period and cannot retaliate against pharmacies for reporting violations or exercising their rights under the new regulations.

Health insurance policies are required to apply amounts paid for brand-name prescription drugs towards cost-sharing requirements, ensuring that patients' out-of-pocket expenses are minimized. Additionally, advanced written notice must be provided to enrollees regarding formulary changes, ensuring stability in medication options for those currently using affected drugs.

Overall, these changes aim to create a more equitable and transparent environment for pharmacies, pharmacists, and patients, significantly impacting the pharmacy and healthcare industries in Wisconsin.

The proposed legislation in Wisconsin aims to reform healthcare costs and prescription drug management, emphasizing affordability, transparency, and access to medications. Key provisions include eliminating cost-sharing for prescription drugs under the Medical Assistance program, capping insulin costs, and establishing a Prescription Drug Affordability Review Board to evaluate drug pricing and set upper payment limits for high-cost medications.

Pharmacy benefit managers (PBMs) will be subject to increased transparency requirements, including the disclosure of profits and financial details related to health plan sponsors. Insulin manufacturers will be mandated to create safety net programs to provide insulin to uninsured or underinsured individuals, ensuring access to medications at reduced costs. Additionally, the legislation introduces a prescription drug importation program to allow the importation of non-brand-name drugs from Canada, aimed at generating savings for residents.

The bill also focuses on diabetes treatment by mandating that disability insurance policies cover expenses for insulin infusion pumps and related supplies, with a cap of $35 for a one-month supply of insulin. The Department of Health Services will explore the implementation of a centralized drug repository program, while the Commissioner of Insurance will report on the progress of the prescription drug importation program.

To enhance oversight of prescription drug affordability, an Office of Prescription Drug Affordability will be created within the Commissioner of Insurance, supported by increased funding. This initiative seeks to improve access to affordable medications for consumers and ensure fair compensation for covered entities in the pharmaceutical industry. Overall, the legislation aims to enhance the operational framework for pharmacies and improve access to affordable prescription drugs for Wisconsin residents.

The proposed legislation introduces comprehensive reforms to the regulation of pharmacy benefit managers (PBMs) in Wisconsin, focusing on enhancing transparency, fairness, and accountability in the pharmaceutical supply chain. Key provisions require PBMs to pay pharmacies a professional dispensing fee that matches state rates and prohibit them from imposing various fees on pharmacies. Additionally, PBMs must allow any licensed pharmacy to participate in their networks under the same terms and conditions, ensuring equitable access for all pharmacies.

The legislation mandates that PBMs provide detailed maximum allowable cost lists to pharmacies, update these lists promptly, and establish an appeal process for pharmacies contesting low reimbursement rates. Furthermore, PBMs are required to notify enrollees of formulary changes well in advance and cannot remove drugs from formularies except at coverage renewal times. This aims to provide stability for patients regarding their medication options.

PBMs are also tasked with acting in the best interests of health benefit plan sponsors, including annual disclosures of profits and payments to consultants. They must remit payments for claims within 30 days and cannot discriminate against 340B covered entities in reimbursement practices. The legislation prohibits PBMs from retaliating against pharmacies for reporting violations or exercising their rights, fostering a more supportive environment for pharmacies.

Auditing practices are also addressed, requiring uniform standards for audits and prohibiting recoupments for errors that do not cause financial harm. The legislation aims to standardize reimbursement rates among pharmacies and protect pharmacies from unfair practices, ultimately benefiting consumers by improving access to pharmaceutical products.

Overall, these changes are designed to create a more transparent and equitable pharmaceutical landscape in Wisconsin, impacting the operations of PBMs, pharmacies, and health insurance providers significantly.

The proposed legislation establishes new requirements for employee benefit plan administrators, insurers of large group health benefit plans, and pharmacy benefit managers (PBMs) regarding the access and ownership of claims data by plan sponsors, such as employers. It mandates that contracts clearly state that plan sponsors own the claims data associated with their contracts, and such data cannot be sold without the consent of both the plan sponsor and the individual involved.

Plan sponsors or their designees are granted the right to request specific claims data and related information up to three times per plan year, covering periods of up to 24 months. Administrators and insurers are required to respond to these requests within seven business days. Additionally, detailed information about high-cost claims, defined as those exceeding $25,000 for non-pharmacy claims and $10,000 for pharmacy claims, must also be provided within the same timeframe.

PBMs are specifically required to furnish detailed data on prescription drug payments, rebate amounts, and claims within seven business days of a written request. They must also disclose any direct or indirect compensation paid to brokers or agents. The act prohibits PBMs from imposing excessive fees or conditions on information requests and ensures that claims data cannot be withheld if the plan sponsor attests to compliance with federal law regarding the use and disclosure of the information.

The legislation aims to enhance transparency in claims processing and costs, significantly impacting the health insurance and pharmacy benefit management industries. By improving access to critical claims data, the changes are expected to empower plan sponsors and potentially alter operational costs for PBMs and plan sponsors due to the new compliance requirements.

AT A GLANCE

This bill requires pharmacy benefit managers in Utah to calculate maximum allowable cost using current comparable prices from multiple national sources and provide electronically searchable MAC lists to pharmacies.

The bill creates a new statutory restriction on the Georgia Board of Community Health regarding pharmacy benefits manager (PBM) contracting under the state employees’ health insurance plan.

It adds a new Code section (45-18-6.2) establishing that, on or after July 1, 2026, the board may not enter into, execute, or renew any contract(s) to provide plan benefits with either: (1) any PBM that owns or has an ownership interest in any retail pharmacy; or (2) any legal entity that contracts with or uses a PBM that owns or has an ownership interest in any retail pharmacy.

The bill includes a transition/limitation provision stating that the new Code section cannot be construed to impair contracts that are in existence on June 30, 2026.

It also repeals all laws and parts of laws in conflict with the act.

AT A GLANCE

This bill requires the Office of Insurance Regulation to enforce uniform audit standards for Florida-licensed pharmacies by July 1, 2026, including cease-and-desist orders and category-based administrative fines.

AT A GLANCE

This bill requires the Agency for Health Care Administration to contract for an annual international reference pricing model and publish AHCA-set reference prices online within 10 days after receiving them.

AT A GLANCE

This bill requires uniform pharmacy audit standards and restricts pharmacy benefit plan audits, including limits on notice, onsite timing, sampling, recoupment, and fraud-designation procedures, for licensed pharmacies.

The bill changes Florida’s consultant pharmacist statute by revising the statutory definition of “health care facility” used in the consultant pharmacist program. Specifically, it adds that a “health care clinic” qualifies as a health care facility when the clinic is owned by a hospital or by one or more physicians who are employed by or contracted with a hospital.

It also revises the scope of facilities already included in the definition by replacing the prior listing/cross-reference for clinics with the new ownership/employment/contract criteria for hospital-associated clinics. All other facility categories in the definition remain as listed (e.g., ambulatory surgical centers and hospitals under Chapter 395; certain addiction treatment facilities; hospices; nursing homes; ambulatory care centers; and nursing home components within continuing care facilities).

The changes take effect July 1, 2026.

AT A GLANCE

This bill prohibits pharmacy benefit managers from restricting covered persons’ pharmacy choice, imposing inconsistent credentialing, or reimbursing for Missouri drug claims below the most recently published NADAC.

AT A GLANCE

This bill generally prohibits pharmacy benefits managers from reimbursing pharmacies or pharmacists below 104% of NADAC or, if unavailable, WAC plus a floor dispensing fee, subject to its complaint process.