pharmacists; pharmacies; reimbursement costs; appeals

HB 2208 requires pharmacy benefit managers (PBMs) to reimburse pharmacies at or above the actual cost paid by the pharmacy for prescription drugs or devices, rather than using lower, negotiated rates. It mandates PBMs to pay professional dispensing fees at the state’s approved medical assistance rate and establishes a 7-business-day appeal process for pharmacies disputing underpayment. Pharmacies that win an appeal must be reimbursed for actual costs, allowed to rebill claims, and have the corrected rate applied to similarly situated pharmacies. The law applies to new or renewed contracts after December 31, 2025, and excludes health insurance coverage managed by the Department of Administration.