Substitute Bill No. 11 aims to improve prescription drug access and affordability in the state, with various provisions set to take effect on July 1, 2025, and January 1, 2026. The bill introduces definitions for key pharmaceutical terms and establishes a pricing framework for identified prescription drugs, prohibiting manufacturers and distributors from selling these drugs above a reference price adjusted by the consumer price index, with exceptions for drugs in shortage. It also imposes civil penalties for violations, calculated as 80% of the revenue difference between actual sales and the reference price, and outlines a process for manufacturers to contest these penalties. Additionally, the bill creates a Prescription Drug Affordability Council to advise on negotiations for prescription drugs and updates Medicaid reimbursement methodologies for nursing home services, emphasizing quality metrics and direct care spending.

The legislation further addresses healthcare regulations by mandating coverage for diabetes treatment, including insulin and related devices, with specific out-of-pocket cost limits. It establishes a framework for the potential importation of prescription drugs from Canada to reduce costs and creates a task force to study emergency preparedness for drug shortages. The bill also includes provisions for regulating pharmacy benefits managers (PBMs), ensuring transparency in pricing, and enhancing access to essential medications. Overall, Substitute Bill No. 11 seeks to enhance accountability, affordability, and access within the pharmaceutical sector while improving healthcare outcomes for residents.

Statutes affected:
Committee Bill:
HS Joint Favorable Substitute:
File No. 420:
JUD Joint Favorable:
APP Joint Favorable: