PBMs Restricted from Engaging in Certain Activities

The legislature recently passed two bills, HB 1919 and HB 1763, which amend the Insurance Code and will be effective September 1, 2021. Both bills prohibit pharmacy benefit managers (PBMs) from engaging in certain self-dealing activities.

HB 1763 focuses on the relationship between PBMs and pharmacists or pharmacies that provide services for the PBMs. The bill prohibits PBMs from reducing claims retroactively, preventing pharmacists or pharmacies under contract with the PBM from mailing or delivering drugs to patients and paying more for claims submitted by affiliated pharmacists or pharmacies than they would pay nonaffiliated providers, and requiring onerous specialty accreditations. The bill also requires PBMs to provide fee schedules to pharmacists or pharmacies, and to provide copies of those contract provisions that relate to the pharmacists’ or pharmacies’ rights and obligations under contracts between the PBMs and the pharmacists or pharmacies that protects patient choice and access to community pharmacy services (and prohibits retaliation against those pharmacists or pharmacies that assert their rights under the contract). 

HB 1919 focuses on the relationship between the PBM and the patient. The bill prohibits PBMs from providing prescription information relating to a patient to pharmacies owned by the PBM for a commercial purpose and from referring the patient to a pharmacy owned by the PBM.

Employers with plans that use PBMs should be aware of these new laws.

HB 1919 »
HB 1763 »