This bill amends existing law to establish that compensation for pharmacy benefits managers (PBMs) must be based solely on a bona fide service fee, eliminating any commission structures or fees that do not meet this criterion. The bona fide service fee is defined as a flat dollar amount that reflects the fair market value for specific services performed on behalf of a purchaser, which would not be passed on to covered persons. The bill specifies that this fee cannot be contingent upon various factors, including drug prices, discounts, rebates, or any other prohibited methodologies.

Additionally, the bill requires that any rate filings submitted by carriers for health benefits plans that include prescription drug coverage must include a memorandum from a qualified actuary detailing the calculation of PBM compensation, along with any necessary supporting records. Carriers are also obligated to provide documentation related to PBM compensation upon request. The act is set to take effect four months after its enactment and will apply to contracts and agreements entered into or modified after that date.

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