This bill allows pharmacies to refuse to fill prescriptions if the reimbursement from pharmacy benefit managers (PBMs) is less than the pharmacy's acquisition cost, explicitly excluding Medicaid and Medicaid care management from this provision. It also introduces new requirements for contracts between pharmacies and PBMs, including the obligation for PBMs to provide information on drug pricing sources and to allow pharmacies to appeal maximum allowable cost pricing decisions. The bill amends existing law by inserting provisions that define pharmacy services administrative organizations and establish penalties for non-compliance with contract requirements, which will be considered violations of the consumer protection act.

Additionally, the bill includes specific language that permits pharmacists to decline to provide certain drugs or services if the reimbursement is inadequate, while requiring them to direct patients to contact their health carrier or PBM for alternative options. The bill repeals certain outdated provisions and clarifies that the new regulations do not apply to Medicaid. The effective date for these changes is set for January 1, 2026, and the fiscal impact is indeterminate, with potential costs associated with increased complaints and enforcement actions by the Department of Justice.

Statutes affected:
As Amended by the Senate: 420-J:8, 358-A:2