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Bill Detail: HB20-1078

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Title Pharmacy Benefit Management Firm Claims Payments
Status Governor Signed (04/01/2020)
Bill Subjects
  • Health Care & Health Insurance
House Sponsors K. Mullica (D)
Senate Sponsors F. Winter (D)
House Committee Health and Insurance
Senate Committee Health and Human Services
Date Introduced 01/08/2020
Description

The bill specifies the amount that a pharmacy benefit management
firm (PBM) is required to reimburse a pharmacy for clean claims and
reasonable dispensing fees.
The bill also prohibits PBMs from retroactively reducing payment
on a clean claim submitted by a pharmacy unless the PBM determines,

through an audit conducted in accordance with state law, that the claim
was not a clean claim. Health insurers that contract with PBMs must
ensure that the PBMs are complying with this prohibition and the
reporting requirements and are subject to penalties for failure to do so.

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