This bill amends existing law to establish that pharmacy benefits managers (PBMs) have a fiduciary duty to prioritize the financial interests of covered persons, in addition to their existing obligations. Under current law, PBMs are required to have the same duty to covered persons as the health benefits plan or carrier they serve. The new provision explicitly states that PBMs must act in good faith and fair dealing while also ensuring that the financial interests of covered persons take precedence over those of the health insurance carriers with whom they contract.

The bill also outlines the responsibilities of carriers in monitoring PBM activities related to prescription drug benefits and mandates that any funds received by PBMs must be used in accordance with their contracts and applicable laws. Additionally, it prohibits carriers or PBMs from charging covered persons more than the lesser of the applicable cost-sharing amount or the out-of-pocket cost for purchasing the medication without insurance. The act is set to take effect 180 days after its enactment and will apply to all relevant contracts and policies issued or renewed thereafter.

Statutes affected:
Introduced: 17B:27F-3.1