The proposed bill seeks to update current statutes governing pharmacy benefit managers (PBMs) by introducing new requirements that enhance patient access to prescription drugs. Under the new provisions, PBMs cannot limit or exclude coverage for a prescription drug that has been previously approved for a covered individual, provided the individual remains insured and the drug is continued through the end of the health care plan year. Additionally, if a PBM or health care insurer intends to change the formulary, they must notify affected individuals and their prescribing providers at least sixty days in advance, detailing the process for requesting continued use of nonformulary drugs. The bill also establishes a structured process for formulary exceptions, requiring timely responses to requests and mandating that denials be communicated in writing with the rationale for the decision. It allows for expedited reviews in urgent situations and ensures that any approved exceptions remain valid through the end of the individual's plan year. The new requirements will apply to contracts and policies entered into or renewed after December 31, 2025, and grant the Director of the Department of Insurance and Financial Institutions the authority to enforce compliance. Overall, the bill aims to improve transparency and accountability from PBMs and health care insurers while ensuring that patients have continued access to necessary medications.

Statutes affected:
Introduced Version: 20-3335, 20-3336
Senate Engrossed Version: 20-3335, 20-3336
Chaptered Version: 20-3335, 20-3336