The bill, 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 includes new sections that prohibit certain practices, such as requiring pharmacists or pharmacies to participate in a pharmacy benefit network or penalizing them for refusing participation. It specifies that any fees charged by health benefit plan issuers or pharmacy benefit managers must be disclosed upfront, and it repeals existing provisions that may conflict with these new regulations. The amendments 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)
House Committee Report: Insurance Code 1369.153, Insurance Code 1369.259, Insurance Code 1369.605 (Insurance Code 1369)