SB252 Alabama 2025 Session

Summary

Primary Sponsor

William “Bill” M. BeasleySenator

Democrat

Session

2025 Regular Session

Title

Pharmacy Benefits Managers; providing a prescription reimbursement rate for independent pharmacies and regulating other practices

Summary

The Community Pharmacy Relief Act would regulate pharmacy benefits managers by forcing a two-year minimum reimbursement floor for independent pharmacies, mandating pass-through of rebates, banning certain fees and steering, increasing cost transparency, and granting the state Insurance Commissioner enforcement powers.

What This Bill Does

It would require PBMs to reimburse independent pharmacies at least the Alabama Medicaid outpatient reimbursement rate for two years, starting Oct. 1, 2025. It bans PBMs from charging fees or using practices that reduce reimbursement or raise patient costs, and from steering or restricting in-network pharmacy choices. It also requires PBMs to pass 100% of manufacturer rebates to health benefit plans (with limited exceptions at the point of sale or for admin fees) and strengthens transparency and enforcement, including penalties and audits by the Insurance Commissioner.

Who It Affects

• Independent pharmacies in Alabama would receive a minimum reimbursement floor (Medicaid rate) for two years, be protected from certain fees that reduce reimbursements, and may receive restrictions on reimbursement methods when a drug is dispensed by another in-network pharmacy (with a required surcharge to the independent).
• Health benefit plans, their PBM providers, and beneficiaries would see rebates pass through to plans (with limited exceptions), have tighter controls on steering and network practices, and be subject to enhanced enforcement, reporting requirements, and potential civil penalties.

Key Provisions

• Section 3 establishes a two-year minimum reimbursement floor for independent pharmacies, set at the Alabama Medicaid Agency's outpatient reimbursement rate, and bans reimbursements lower than that rate.
• Section 4 requires PBMs to pass through 100% of manufacturer rebates to health benefit plan clients (with possible exceptions at point of sale or for admin fees), and Section 14 further clarifies pass-through or retention rules; Section 8 and related provisions restrict steering, prohibit exclusive mail-order requirements, and limit adverse in-network effects.
• Section 5–6 provide enforcement by the Commissioner of Insurance, including civil penalties of at least $1,000 per violation, examination/audit rights, potential testimony/hearings, and a complaint filing fee (up to $100) that can be repaid if the violation is proven.
• Section 27-45A-13 adds a minimum reimbursement, prohibits lowering reimbursement during adjudication, restricts increasing cost-sharing to recoup costs, and requires a surcharge if an independent pharmacy is bypassed in favor of dispensing at a different in-network pharmacy.
• Section 27-45A-14 requires pass-through of rebates by PBMs to health benefit plan clients, with limited opt-out directions from the plan.

AI-generated summary using openai/gpt-5-nano on Feb 22, 2026. May contain errors — refer to the official bill text for accuracy.

Subjects

Insurance