Pharmacy benefits managers are third-party administrators of prescription drug benefits in a health insurance plan. They are primarily responsible for processing and paying prescription drug claims. They typically negotiate price discounts and rebates from manufacturers and determine how pharmacies get reimbursed for dispensing prescriptions. Under state law, pharmacy benefits managers are licensed and regulated by the Department of Insurance. This bill would prohibit pharmacy benefits managers from reimbursing a pharmacy less than the actual acquisition cost paid by the pharmacy and would prohibit pharmacy benefits managers from charging pharmacies or pharmacists miscellaneous fees related to network participation and claims processing. This bill would permit pharmacists to disclose information to consumers about drug prices and alternative drugs for treatment. This bill would recognize the right of a pharmacy to refuse to dispense a drug when the pharmacy would be reimbursed less than a pharmacy's dispensing cost, and would further prohibit a pharmacy benefits manager from recovering the pharmacy's dispensing cost by requiring a consumer to pay a higher deductible or copayment. This bill would specify that the Commissioner of Insurance may enforce violations of the Alabama Pharmacy Benefits Manager Licensure and Regulation Act committed by a pharmacy benefits manager during an audit of a pharmacy, and may also enforce the Pharmacy Audit Integrity Act in relation to auditing of a pharmacy by a pharmacy benefits manager.

Statutes affected:
Introduced: 27-45A-3, 27-45A-6, 27-45A-7, 27-45A-8, 27-45A-10