The bill introduces significant amendments to the operations of pharmacy benefits managers (PBMs) in relation to health carriers, requiring a written agreement that outlines the PBM's duties and fiduciary responsibilities. It raises the maximum administrative fine for violations from $2,500 to $10,000 per violation, with each day of non-compliance counted as a separate violation. Additionally, pharmacies are mandated to inform consumers of their right to request the lowest available price for prescription drugs, and health carriers or PBMs are prohibited from penalizing or incentivizing individuals to use specific pharmacy providers. The bill also enhances reporting requirements, necessitating semi-annual financial reports from PBMs to the commissioner, while ensuring that the acts of a PBM are considered the acts of the health carrier they represent.

Further provisions include a structured process for appealing maximum allowable cost pricing disputes, a requirement for health plans to provide clear written notices regarding formulary deletions with an extended notice period of 60 days, and new regulations on retroactive claims denials. The bill also establishes new definitions for PBMs and spread pricing, while ensuring that pharmacies inform consumers about pricing options for prescription drugs. Set to take effect on January 1, 2027, the legislation aims to improve transparency and fairness in drug pricing and insurance practices, with a projected minimal fiscal impact of less than $10,000 annually from 2026 to 2029.

Statutes affected:
Introduced: 318:5-a
As Amended by the Senate: 402-N:1, 402-N:2, 420-J:8, 420-J:7-b, 420-J:8-b, 415-A:7