New law → Short summary

SAMPLE LAW. Written for this demo in the style of a state PBM law. Not a real law. AN ACT relating to the pass-through of manufacturer rebates by pharmacy benefit managers. SECTION 1. DEFINITIONS. (a) "Pharmacy benefit manager" means a person that administers prescription drug benefits on behalf of a health benefit plan sponsor. (b) "Rebate" means any discount, price concession or payment received by a pharmacy benefit manager from a drug manufacturer that is based on utilization of a prescription drug. (c) "Plan sponsor" means the employer, insurer or other entity that establishes or maintains a health benefit plan. SECTION 2. APPLICABILITY. (a) This Act applies to a pharmacy benefit manager that administers benefits for a fully insured health benefit plan or a self-funded plan subject to the jurisdiction of this state. (b) This Act does not apply to a pharmacy benefit manager to the extent it administers benefits under the state Medicaid managed care program. SECTION 3. PASS-THROUGH OF REBATES. (a) A pharmacy benefit manager shall pass through one hundred percent of all rebates received to the plan sponsor. (b) Rebates shall be remitted to the plan sponsor not later than the 90th day after the end of the calendar quarter in which the rebate was received. SECTION 4. FEES. (a) A pharmacy benefit manager may charge a plan sponsor a reasonable administrative fee disclosed in the contract. (b) Payments received from a manufacturer for administrative services shall be treated in accordance with Section 3 where appropriate. SECTION 5. ATTESTATION. (a) A pharmacy benefit manager shall file an annual attestation of compliance with this Act with the Department of Insurance. (b) The first attestation is due not later than March 31, 2027. SECTION 6. EFFECTIVE DATE. This Act takes effect January 1, 2027, and applies to a contract entered into or renewed on or after that date.