The bill seeks to enhance regulation of pharmacy benefit managers (PBMs) by instituting new reporting requirements, prohibiting certain practices, and promoting transparency in drug reimbursement processes. Key provisions include mandates for PBMs to report on drug reimbursement appeals, restrictions on retroactive claim denials, and a ban on charging pharmacies fees related to claim adjudication. Additionally, reimbursements to pharmacies must not fall below the national average drug acquisition cost plus applicable dispensing fees, and practices such as spread pricing and retroactive fees are prohibited. The legislation also amends existing laws governing PBM audits, requiring timely reporting and limiting the audit period to six months, while mandating that any contract changes between PBMs and pharmacies be disclosed 45 days in advance and agreed upon in writing.

Moreover, the bill allows pharmacies to refuse to provide pharmacist services if the reimbursement from a PBM is less than the pharmacy's acquisition cost for those services. It modifies existing language in W.S. 26-22-503(c) to replace "medical" with "health care," facilitating contracts for health care services outside of Wyoming while allowing insureds to utilize Wyoming providers. The bill also allocates $439,000 for the Department of Insurance to fund one full-time position and one at-will contract position to implement and administer the act. The act is scheduled to take effect on July 1, 2023, with certain sections becoming effective on July 1, 2024, and others immediately upon completion of necessary legislative processes.

Statutes affected:
Introduced: 9-3-205, 26-22-502, 26-52-101, 26-52-102, 26-52-103, 26-52-104, 26-22-503