Drug Prices and Coverage

Removed all text defining pharmacy benefit manager transparency, including rules on administrative appeals for drug pricing and reimbursement challenges.

Added requirements for the Department of Health to submit monthly detailed accounting reports to the Governor and legislative committees regarding ADAP implementation.

Added provisions to appropriate funds for the Ryan White Part B AIDS Drug Assistance Program through a specified date.

Added a specific definition for the term 'low income' for the purpose of determining ADAP eligibility.

Updated the bill's page count from 5 to 8 pages due to the insertion of new ADAP-related text.

All provisions related to international drug reference pricing, including the creation of a new statute for the Agency for Health Care Administration to analyze foreign drug prices, were removed.

Sections requiring health insurers and HMOs to limit drug reimbursements to reference prices and to use savings for specific purposes were deleted.

Provisions prohibiting pharmacy benefit managers from offering certain formularies and requiring them to limit changes to drug lists were removed.

New specific requirements were added mandating that PBM contracts include a clear administrative appeal process, including contact methods, a 30-day deadline for responses, and the option to appeal multiple claims together.

The definition of 'pharmacy benefits plan or program' was expanded to include discount card programs and government-funded plans, but explicitly excludes plans serving PACE organizations.

The bill's title and short description were changed to reflect the removal of the international pricing and insurer reimbursement components, focusing solely on PBM transparency and appeal procedures.