The bill amends the Pharmacy Benefits Manager Regulation Act to introduce new definitions and prohibit certain practices by pharmacy benefits managers (PBMs). Notably, it defines "patient steering" and "spread pricing," which refer to practices that direct patients to specific pharmacies and involve charging insurers more than what pharmacies are reimbursed, respectively. The bill also clarifies that PBMs cannot engage in patient steering or spread pricing, and it establishes that clerical errors identified during audits will not constitute fraud unless they result in actual overpayments or incorrect medications being dispensed.

Additionally, the bill mandates that PBMs must provide pharmacies with contracts in plain English and cannot require participation in one contract to access another. It prohibits PBMs from using misleading advertisements, imposing excessive validation standards, or restricting pharmacists from discussing costs with patients. The legislation aims to enhance transparency and fairness in pharmacy benefit management, ensuring that pharmacies and pharmacists can operate without undue restrictions imposed by PBMs.

Statutes affected:
introduced version: 59A-61-2, 59A-61-5