HB492 Alabama 2021 Session

Under existing law, pharmacy benefits managers must be licensed by the Department of Insurance. Pharmacy benefits managers provide claims processing services or prescription drug and other pharmacist services, or both, to health benefit plans

This bill would require insureds to receive certain prescription drug rebates and discounts

This bill would prohibit a pharmacy benefits manager from reimbursing a pharmacy in an amount less than the amount the pharmacy benefits manager reimburses an affiliated pharmacy of the pharmacy benefits manager and from paying a pharmacy for prescription drugs an amount different than the amount the pharmacy benefits manager contracted with the health benefit plan to charge the health benefit plan for those same prescription drugs

This bill would prohibit a pharmacy benefits manager from requiring or steering an insured to use a mail-order pharmacy or a pharmacy affiliated with a pharmacy benefits manager

This bill would require a pharmacy benefits manager to act as a fiduciary and annually report drug rebate information to health insurers and health benefit plans

This bill would prohibit a pharmacy benefits manager from imposing conditions to influence an insured in selecting a certain pharmacy or otherwise limiting an insured's ability to select a pharmacy of his or her choice

This bill would prohibit a pharmacy benefits manager from limiting certain powers of a pharmacy or pharmacist to provide pharmacist services to insureds

This bill would provide further for the Commissioner of Insurance to enforce laws relating to pharmacy benefits managers and would provide civil penalties for violations

This bill would also provide conforming changes to definitions

Relating to health care; to amend Sections 3 through of Act 2019-457, 2019 Regular Session, now appearing as Sections 27-45A-3, 27-45A-4, and 27-45A-5, Code of Alabama 1975; to amend and renumber Section 6 of Act 2019-457, 2019 Regular Session, now appearing as Section 27-45A-6, Code of Alabama 1975; and to add Sections 27-45A-6, 27-45A-7, 27-45A-8, 27-45A-9, 27-45A-10, 27-45A-11, and 27-45A-13 to the Code of Alabama 1975; to renumber Section 7 of Act 2019-457, 2019 Regular Session, now appearing as Section 27-45A-7, Code of Alabama 1975; to require insureds to receive certain prescription drug rebates and discounts; to prohibit a pharmacy benefits manager from reimbursing a pharmacy in an amount less than the amount the pharmacy benefits manager reimburses an affiliated pharmacy of the pharmacy benefits manager and from paying a pharmacy for prescription drugs an amount different than the contracted amount; to prohibit pharmacy benefits managers from steering an insured to use a mail-order pharmacy or a pharmacy benefits manager affiliate; to require a pharmacy benefits manager to act as a fiduciary to its clients and report certain drug rebates; to prohibit pharmacy benefits managers from limiting an insured's ability to select a pharmacy of his or her choice; to prohibit a pharmacy benefits manager from limiting certain powers of a pharmacy or pharmacist; to revise definitions; to provide further for the Commissioner of Insurance to enforce laws relating to pharmacy benefits managers; and to provide civil penalties for certain violations; and to make conforming changes to definitions.