The "Patient and Provider Protection Act" introduces several key provisions aimed at regulating pharmacy benefits managers (PBMs) and their interactions with carriers and pharmacies. The bill mandates that PBMs have a fiduciary duty to act in the best interests of the carriers they contract with and prohibits them from using misleading marketing practices to influence covered persons' 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 establishes that contracts between PBMs and pharmacies are presumed to be contracts of adhesion, which allows for special scrutiny in disputes.

Furthermore, the legislation requires PBMs to reimburse contracted or network pharmacies at rates that meet or exceed the pharmacies' acquisition costs for prescription drugs, as well as adhere to state-defined benchmarks for reimbursement. It also prohibits differential payment pricing, ensuring that all contracted pharmacies receive the same reimbursement rate regardless of ownership. The bill includes provisions for a pharmacy and therapeutics committee to ensure that formulary decisions do not favor higher-cost drugs over lower-cost generics or biosimilars. Notably, the bill inserts new language to enhance transparency and accountability in the operations of PBMs while deleting certain outdated provisions related to self-insured health benefits plans.

Statutes affected:
Introduced: 17B:27F-3.3, 17B:27F-3.4, 17B:27F-1