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 practices like spread pricing, mandating the use of mail-order pharmacies, and imposing stricter terms on unaffiliated specialty pharmacies. It also allows network pharmacies and pharmacists to refuse to provide drugs if the reimbursement is below acquisition cost, thereby enhancing their rights and protections.

Additionally, the bill sets forth requirements for specialty pharmacies that ship clinician-administered drugs, ensuring compliance with federal regulations and access to pharmacists for inquiries. It prevents health benefit plans and PBMs from penalizing providers who refuse to administer drugs from specialty pharmacies if they believe it may harm patients. The legislation also addresses spread pricing in contracts between PBMs and health benefit plans, prohibiting its inclusion in new contracts after January 1, 2026, and requiring all contracts to exclude it by 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