The proposed legislation, General Assembly Raised Bill No. 1366, aims to enhance regulations surrounding pharmacy benefits managers (PBMs) and their contracts with health carriers and pharmacies. Key provisions include the prohibition of contract clauses that penalize pharmacists for disclosing medication costs or alternative purchasing options to consumers, effective January 1, 2026. Additionally, the bill allows PBMs to charge health benefit plans different prices for pharmacy services than what they pay pharmacies, and to impose fees based on various pricing metrics and savings. The bill also mandates that health carriers cannot require individuals to pay more than the lesser of their copayment, the allowable claim amount, or the cash price for medications.

Furthermore, the bill establishes a fiduciary duty for PBMs towards health carriers, pharmacies, and covered individuals, requiring them to disclose any conflicts of interest. It also imposes a duty of good faith and fair dealing in their operations. The Insurance Commissioner is tasked with enforcing these provisions and will be required to report annually on health carriers' rebate practices, including how rebates are accounted for and their impact on cost-sharing. The report will now include additional metrics on rebate dollars used to reduce cost-sharing requirements. The bill is set to take effect in stages, with certain provisions starting on January 1, 2026, and others on October 1, 2025.

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