S.B. No. 1236 aims to enhance the relationship between pharmacists or pharmacies and health benefit plan issuers or pharmacy benefit managers by introducing several amendments to the Insurance Code. Notably, it adds a new subsection (e) to Section 1369.153, stipulating that a group number on an identification card can only be assigned to enrollees in applicable health benefit plans. Additionally, the bill modifies Section 1369.259 by changing its heading to emphasize limitations on payment adjustments and prohibiting the use of extrapolation. It also introduces new subsections that restrict health benefit plan issuers or pharmacy benefit managers from denying or reducing claim payments post-adjudication, except under specific circumstances such as fraud or clerical errors.

Furthermore, the bill establishes new sections that mandate online access to pharmacy benefit network contracts, require mutual agreement for adverse material changes to contracts, and outline the notification process for proposed modifications. It prohibits health benefit plan issuers or pharmacy benefit managers from charging fees before providing full contract details and ensures that pharmacists or pharmacies cannot be penalized for refusing to participate in a pharmacy benefit network. The changes will take effect on September 1, 2025, and will apply to health benefit plans and contracts entered into or renewed after this date.

Statutes affected:
Introduced: Insurance Code 1369.153, Insurance Code 1369.252, Insurance Code 1369.259, Insurance Code 1369.605 (Insurance Code 1369)
Senate Committee Report: Insurance Code 1369.153, Insurance Code 1369.259, Insurance Code 1369.605 (Insurance Code 1369)
Engrossed: Insurance Code 1369.153, Insurance Code 1369.259, Insurance Code 1369.605 (Insurance Code 1369)
House Committee Report: Insurance Code 1369.153, Insurance Code 1369.259, Insurance Code 1369.605 (Insurance Code 1369)
Enrolled: Insurance Code 1369.153, Insurance Code 1369.259, Insurance Code 1369.605 (Insurance Code 1369)