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Bill Detail: HB20-1198

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Title Pharmacy Benefits Carrier And Pharmacy Benefit Manager Requirements
Status Introduced In House - Assigned to Health & Insurance (01/30/2020)
Bill Subjects
  • Health Care & Health Insurance
House Sponsors J. Buckner (D)
L. Landgraf (R)
Senate Sponsors R. Fields (D)
J. Ginal (D)
House Committee Health and Insurance
Senate Committee
Date Introduced 01/30/2020

The bill imposes requirements regarding the administration of
prescription drug benefits under health benefit plans as follows:
  • Requires a health insurer to submit to the commissioner of
insurance a list of pharmacy benefit managers (PBMs) the
health insurer uses to manage or administer prescription
drug benefits under its health benefit plans offered in this

  • Requires health insurers and PBMs to submit their
programs for compensating pharmacies and pharmacists
and their prescription drug formularies under their
prescription drug benefits plans, and the commissioner is
authorized to review the compensation programs to ensure
they are fair and reasonable to provide an adequate network
of pharmacies and pharmacists under their prescription
drug benefits plans;
  • Requires a PBM to also report to the commissioner the
amount the PBM expects to be reimbursed from health
insurers for pharmacist services;
  • Prohibits health insurers and PBMs from:
  • Causing or knowingly permitting the use of any
untrue, deceptive, or misleading advertisement,
promotion, solicitation, representation, proposal, or
  • Charging a pharmacy or pharmacist a fee for
adjudicating a claim;
  • Requiring stricter pharmacy accreditation standards
or certification requirements than the standards or
requirements that are required by the state board of
  • Reimbursing an independent pharmacy or
pharmacist an amount that is less than the amount
the health insurer or PBM reimburses an affiliated
pharmacy or pharmacist; and
  • Modifying their prescription drug formulary at any
time during the benefit year.
  • If a pharmacy or pharmacist is eliminated from a health
care provider or PBM network, specifies that the health
insurer or PBM is not relieved of any obligation to pay for
pharmacist services properly rendered before elimination
from the network; and
  • Requires health insurers and PBMs to report specified
claims data to the commissioner and the all-payer health
claims database.
The commissioner is authorized to adopt rules to implement the
bill and to enforce the bill using all powers granted the commissioner
under the insurance laws of this state. A health insurer is:
  • Responsible for complying with the bill and ensuring any
PBM the health insurer uses is complying with the bill; and
  • Liable for failure of the health insurer or PBM to comply.

Committee Reports
with Amendments
Full Text
Full Text of Bill (pdf) (most recent)
Fiscal Notes  
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