The proposed bill, titled the "Prescription Benefit Manager Accountability Act," aims to enhance the accountability of prescription benefit managers (PBMs) in the administration of prescription drug benefits. It mandates that whenever a prescribing practitioner prescribes a specific medication for a patient, the PBM must approve and authorize coverage for that medication as written if the practitioner submits a notarized letter stating the medical necessity for the specific medication and that alternative medications are not as effective or clinically appropriate for the patient. The bill prohibits PBMs from substituting, denying, or requiring step therapy for the prescribed medication based on the submitted documentation.

Additionally, the bill stipulates that any denial of a prescribed medication must be made only after review by a licensed healthcare professional with documented medical expertise in the specific medication or the medical condition for which it is prescribed. The PBM is required to document the review process, including the name, license number, and specialty of the reviewing professional, the relevant medical expertise, and the clinical basis for the denial. This documentation must be provided to both the prescribing practitioner and the patient upon request.

Violations of this act are classified as unfair or deceptive acts or practices and may be enforced by the attorney general. The Department of Health is authorized to promulgate rules and regulations necessary to implement this chapter. The act will take effect upon passage.