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Pharmacy benefits managers; requirements, application of law, report, delayed effective date.
Pharmacy benefits managers; requirements; scope; report. Requires all health insurance carriers to use the pass-through pricing model and may limit a pharmacy benefits manager from deriving income from pharmacy benefits management services provided to a carrier except for income derived from a pharmacy benefits management fee. The bill prohibits a pharmacy benefits manager from (i) reversing and or resubmitting the claim of a pharmacist or pharmacy without meeting certain requirements, (ii) redu…
Source: OpenStates · fetched April 13, 2026
May affect the income and operational models of pharmacy benefits managers, who are often employees or contractors.
- W-2 worker (non-union)indirectModerate impactMedium certainty
May affect the income and operational models of pharmacy benefits managers, who are often employees or contractors.
“may limit a pharmacy benefits manager from deriving income from pharmacy benefits management services provided to a carrier except for income derived from a pharmacy benefits management fee.”· Pharmacy benefits managers; requirements; scope; report.
- Requires health insurance carriers to use the pass-through pricing model.
- Limits pharmacy benefits managers' income sources to fees, prohibiting other derivations from services provided to carriers.
- Prohibits pharmacy benefits managers from reversing or resubmitting pharmacist/pharmacy claims without meeting specific requirements.
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