No. CS/HB 697
Filed under Insurance.
Drug Prices and Coverage ; Revises definition of term "pharmacy benefits plan or program" to exclude plan or program that exclusively serves PACE organization; requires contracts between pharmacy benefit managers & participating pharmacies to allow specified option in administrative appeal procedure; provides pharmacy benefit manager prohibited practices relating to pharmacies & pharmacists. APPROPRIATION: $30,901,933
Plain English Summary
AI-GENERATEDPharmacy benefit managers may no longer force pharmacies to dispense drugs when the reimbursement rate falls below the pharmacy's actual acquisition cost.
PBM contracts must now allow pharmacies to file a single consolidated appeal for multiple claims involving the same drug within one calendar month.
The bill appropriates $30.9 million to the Department of Health to fund the AIDS Drug Assistance Program through June 30, 2026.
ADAP must distribute medications directly to eligible individuals and cannot provide services through the purchase of health insurance.
AIProhibits PBMs from restricting pharmacies from declining to dispense drugs when reimbursement is below acquisition cost, and prohibits paying affiliated pharmacies more than independent ones.
AIRequires PBM appeal procedures to allow pharmacies to submit a single consolidated appeal for multiple claims of the same drug within a calendar month.
AIAppropriates $30.9M for the AIDS Drug Assistance Program, mandates direct medication distribution rather than insurance purchase, and requires monthly detailed financial and utilization reports to legislative leadership.
AIExcludes plans that exclusively serve PACE organizations from the statutory definition of pharmacy benefits plan or program.