The bill amends the Pharmacy Benefit Manager Licensure and Regulation Act to strengthen the oversight of pharmacy benefit managers (PBMs) and their relationships with pharmacies and health benefit plans. It introduces definitions for terms such as "clinician-administered drug," "maintenance medication," and "specialty pharmacy," which clarify the responsibilities of various healthcare stakeholders. The legislation prohibits PBMs from using spread pricing and imposes restrictions on their management of specialty pharmacies, ensuring that the terms for unaffiliated pharmacies are not more stringent than those for affiliated ones. Additionally, network pharmacies and pharmacists are allowed to refuse to provide drugs if the reimbursement falls below the acquisition cost.

The bill also outlines guidelines for the shipment and administration of clinician-administered drugs, mandating that specialty pharmacies adhere to federal regulations and support healthcare providers adequately. It prevents health benefit plans and PBMs from requiring covered individuals to use specific pharmacies or mail-order services, thereby preserving patient choice. Furthermore, the legislation enhances the rights of network pharmacies by prohibiting retaliation from PBMs for declining to provide drugs and allowing retail pharmacies to offer delivery services without penalties. A timeline is established for the elimination of spread pricing in contracts, with a complete prohibition set for January 1, 2029. The act will take effect on January 1, 2026, and repeals certain sections of the Revised Statutes Cumulative Supplement, 2024.

Statutes affected:
Introduced: 44-4601, 44-4603, 44-4608, 44-4611
Final Reading: 44-4601, 44-4603, 44-4610
Slip Law: 44-4601, 44-4603, 44-4610