The proposed Substitute Bill No. 11 aims to enhance prescription drug access and affordability in the state, with several key provisions set to take effect on various dates, including July 1, 2025. The bill introduces definitions for terms related to pharmaceuticals and establishes a pricing framework for identified prescription drugs, which cannot exceed a reference price adjusted by the consumer price index, starting January 1, 2026. It includes penalties for non-compliance, allowing civil penalties based on sales revenue exceeding the reference price, and mandates that pharmaceutical manufacturers and distributors file annual statements electronically. The bill also creates a Prescription Drug Affordability Council to advise on negotiations for prescription drugs and allows drug purchasing agencies to negotiate bulk prices.

Additionally, the bill significantly reforms Medicaid reimbursement for nursing homes, emphasizing quality metrics and requiring facilities to allocate at least 80% of their funding to direct resident care by July 1, 2025. It expands emergency Medicaid coverage, raises asset limits for the HUSKY C health program, and mandates comprehensive coverage for diabetes treatment under group health insurance policies. The bill also establishes a Canadian prescription drug importation program, requiring wholesalers to maintain rigorous documentation and comply with federal safety standards. Overall, Substitute Bill No. 11 seeks to improve healthcare access, regulate pharmaceutical pricing, and enhance the quality of care in nursing homes while ensuring accountability and transparency in the healthcare system.

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