Relating to the relationship between pharmacists or pharmacies and health benefit plan issuers or pharmacy benefit managers.
What changed between versions
Added new provisions requiring health benefit plan issuers and pharmacy benefit managers to provide secure online portals for pharmacists to access all pharmacy benefit network contracts and addendums.
Modified recoupment rules to limit when issuers can recover payments from pharmacies, allowing recoupment only for fraudulent claims, incorrect payments, or substantive errors, with separate rules for clerical errors.
Added requirements that adverse material changes to pharmacy benefit network contracts require mutual agreement between parties and cannot take effect until 120 days after written affirmative agreement.
Added new sections requiring advance notice (90 days) for non-adverse contract modifications and electronic disclosure of fee schedules.
Added prohibitions on requiring pharmacists to participate in pharmacy benefit networks or penalizing them for refusing to participate.
Extended effective date to September 1, 2025, with provisions applying to plans and contracts starting January 1, 2026.