HB238 Alabama 2024 Session

Summary

Primary Sponsor

Phillip Rigsby Representative

Republican

Session

Regular Session 2024

Title

Pharmacy Benefits Managers; Providing more regulation

Description

Pharmacy benefits managers are third-party administrators of prescription drug benefits in a health insurance plan. They are primarily responsible for processing and paying prescription drug claims.

They typically negotiate price discounts and rebates from manufacturers and determine how pharmacies get reimbursed for dispensing prescriptions. Under state law, pharmacy benefits managers are licensed and regulated by the Department of Insurance.

This bill would prohibit pharmacy benefits managers from reimbursing a pharmacy less than the actual acquisition cost paid by the pharmacy or from contracting with a health insurer to receive payment amounts for prescription drug benefits that are different from the amounts the pharmacy benefits managers pay pharmacies. This bill would also prohibit pharmacy benefits manufacturers from starting an investigation against a pharmacy for fraud, waste, or abuse without reasonable suspicion.

This bill would further specify the powers that the Commissioner of Insurance may use to investigate pharmacy benefits managers and would make pharmacy benefits managers subject to the Pharmacy Audit Integrity Act in cases involving fraud, waste, or HB238 INTRODUCED abuse.

This bill would require pharmacy benefits managers to pass on 100 percent of the rebates that they receive from pharmaceutical manufacturers and would provide reporting requirements on rebates received by pharmacy benefits managers to both the commissioner and health insurers.

This bill would also prohibit pharmacy benefits managers from penalizing health insurers when they transfer claims processing services and related functions to a different pharmacy benefits manager.

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Subjects

Health