House Bill 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. Notably, it mandates that health benefit plans providing pharmacy benefits must include a unique identifier on the front of each enrollee's identification card, allowing pharmacists to determine the regulatory status of the enrollee's plan. Additionally, the bill outlines specific conditions under which claim payments to pharmacists can be denied or reduced after adjudication, emphasizing that such actions can only occur in cases of fraud, prior payment for the same service, or significant errors leading to incorrect prescriptions.

The bill also introduces new sections that require health benefit plan issuers and pharmacy benefit managers to provide online access to pharmacy benefit network contracts, ensuring transparency and allowing pharmacists to review contract modifications before they take effect. Furthermore, it prohibits certain fees related to participation in pharmacy benefit networks and establishes that pharmacists cannot be penalized for opting out of these networks. 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)