The proposed "Pharmacy Benefit Managers Act" introduces a regulatory framework for pharmacy benefit managers (PBMs) within Title 27 of the General Laws concerning insurance. Under this act, PBMs are required to obtain a valid certificate of authority from the health insurance commissioner to operate legally in the state. The bill defines key terms related to pharmacy benefit management and outlines the services provided by PBMs, including claims processing, formulary management, and the administration of prescription drug benefits.

The act mandates that PBMs submit detailed annual reports disclosing financial arrangements, including pricing discounts, rebates, and patient utilization data, thereby enhancing transparency and accountability in their operations. It establishes an application process for obtaining the certificate of authority, which requires the submission of organizational documents, financial statements, and a business plan.

The health insurance commissioner is empowered to oversee PBMs, with the authority to revoke or suspend certificates for violations, including providing materially incorrect information or engaging in fraudulent practices. Additionally, PBMs must report any administrative or criminal actions taken against them in other jurisdictions within specified timeframes.

Penalties for non-compliance include restitution and fines, which may be directed to a health insurance market integrity fund. The act is set to take effect on January 1, 2027, emphasizing the need for regulatory oversight to protect consumers and maintain market integrity in the pharmacy benefit management sector.