The "Patient and Provider Protection Act" introduces several key provisions aimed at regulating pharmacy benefits managers (PBMs) and their interactions with pharmacies and manufacturers. Notably, the bill establishes that PBMs have a fiduciary duty to prioritize the long-term health outcomes of covered persons and prohibits them from using misleading marketing practices to influence patients' pharmacy choices. Additionally, any agreement between a PBM and a manufacturer that conditions rebates on the exclusion of generic drugs from coverage is deemed invalid. The bill also presumes contracts between PBMs and pharmacies to be contracts of adhesion, which allows for greater scrutiny in disputes due to the imbalance of bargaining power.

Furthermore, the bill mandates that PBMs reimburse contracted and independent pharmacies fairly, ensuring that contracted pharmacies receive at least the cost of acquiring prescription drugs, while independent pharmacies can be reimbursed at a rate up to five percent lower than the lowest rate for contracted pharmacies, but not below their acquisition cost. The legislation also requires pharmacy and therapeutics committees to ensure that higher-cost prescription drugs are not favored over lower-cost generic or biosimilar options in formulary decisions. These measures aim to enhance transparency and fairness in the pharmaceutical benefits landscape.

Statutes affected:
Introduced: 17B:27F-3.3, 17B:27F-3.4