Pharmacy Benefit Managers; requiring PBM to remit certain fees. Effective date.

The list of bill sponsors was updated in the enrolled version to include Burns, West, and Archer, who were not listed in the engrossed version.

Minor text formatting errors present in the engrossed draft (e.g., repeated words like 'must PBM shall') were retained in the final enrolled version without correction.

PBMs must update their Maximum Allowable Cost (MAC) pricing lists at least every seven days and provide a process for providers to access these lists.

PBMs must provide documented proof from wholesalers showing that a drug is available at a price below their reimbursement rate when denying a below-cost appeal.

A new rule states that any appeal resulting in a reimbursement rate below the pharmacy's acquisition cost is considered a denial, triggering specific appeal procedures.

PBMs are prohibited from requiring pharmacies to collect additional money from patients or plan sponsors after a successful below-cost reimbursement appeal.

PBMs cannot place a drug on their pricing list unless there are at least two therapeutically equivalent generic drugs available.

The bill clarifies that all appeal requirements apply to every payment method PBMs use, including average acquisition cost, manufacturer price, and wholesale price.

Administrative fees for reversing a reimbursement increase after an appeal are increased to $500 if unpaid after 90 days and to $1,000 if unpaid after 180 days.