H.B. No. 3317 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. Key provisions include the establishment of limitations on payment adjustments and recoupments, ensuring that health benefit plan issuers or pharmacy benefit managers cannot deny or reduce claim payments after adjudication, except under specific circumstances such as fraud or clerical errors. Additionally, the bill mandates that health benefit plan issuers or pharmacy benefit managers provide online access to pharmacy benefit network contracts and disclose any adverse material changes to these contracts, requiring mutual agreement for such changes to take effect.

The bill also introduces new sections that outline the requirements for pharmacy benefit network contracts, including the necessity for clear communication regarding modifications and the prohibition of fees before providing full contract details to pharmacists or pharmacies. Furthermore, it prohibits health benefit plan issuers or pharmacy benefit managers from requiring participation in a pharmacy benefit network or penalizing those who refuse. The amendments will take effect on September 1, 2025, and will apply to health benefit plans and contracts entered into or renewed after that date.

Statutes affected:
Introduced: Insurance Code 1369.153, Insurance Code 1369.252, 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)