SB93 Alabama 2025 Session

Summary

Primary Sponsor

Andrew JonesSenator

Republican

Session

2025 Regular Session

Title

Pharmacy Benefits Managers; providing additional regulation of practices

Summary

SB93 would tighten Alabama regulation of Pharmacy Benefits Managers to ensure fair reimbursement, limit fees, improve price transparency, and strengthen enforcement.

What This Bill Does

The bill bans PBMs from reimbursing pharmacies less than their actual acquisition cost and from charging certain network or claims processing fees. It requires PBMs to reimburse a uniform, predetermined professional dispensing fee that is not below what Alabama pays under federal program rules, with the dispensing cost borne by the PBM, not the patient. It allows pharmacists to disclose price information and treatment alternatives to consumers and protects a pharmacy's right to refuse dispensing if reimbursement is too low, without shifting dispensing costs to patients. It also expands enforcement and oversight, giving the Insurance Commissioner new tools to enforce rules and handle audits, with an effective date of October 1, 2025.

Who It Affects

• Pharmacists and pharmacies in Alabama would be protected from underpayment and excessive fees, gain a defined dispensing cost reimbursement, and have clearer rights when reimbursement is inadequate.
• Covered individuals (patients) and health benefit plans would benefit from price transparency, protections against network steering, and less risk of higher costs due to PBM practices, while retaining options to choose in-network pharmacies.

Key Provisions

• Prohibits PBMs from reimbursing a pharmacy less than the pharmacy's actual acquisition cost and from charging pharmacies miscellaneous network participation or claims-processing fees.
• Requires PBMs to reimburse a predetermined, average professional dispensing fee (cost borne by the PBM, not the patient) that is not below the amount paid by Alabama under Title XIX; AAC or WAC-based definitions are used to determine actual costs.
• Defines key terms (AAC, PBM Affiliate, Claims Processing Services, Covered Individual, Health Benefit Plan, In-Network, etc.) and prohibits spread pricing in Alabama.
• PBMs may not require a covered individual to obtain drugs exclusively through mail-order or an PBM affiliate, nor may they penalize patients for choosing in-network pharmacies; patient choice must be respected under contract terms.
• Prohibits monetary advantages or penalties to influence a patient’s choice of pharmacy and prohibits using a patient’s cost-share data to steer to certain pharmacies or mail-order options.
• Requires claims to include a modifier indicating an agreement under 42 U.S.C. § 256b and restricts PBMs from penalizing pharmacists for disclosure of cost, alternatives, or reimbursement information.
• Allows pharmacists to disclose price, cost, and alternative drug information to patients, and prohibits penalties for such disclosures; delivery of medications may be offered as an ancillary service if certain conditions are met and no extra fees are charged to the PBM or insurer.
• Adds enforcement provisions: the Commissioner of Insurance may enforce violations during audits and under the Pharmacy Audit Integrity Act; creates an appeals/mediation process for audit findings; authorizes investigation of auditing entities and complaints, with an effective date of October 1, 2025.

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