State pharmacy benefits manager; DMAS to select & contract with a third-party administrator to serve

Removed the requirement to select and contract with a single pharmacy benefits manager by July 1, 2026.

Added a requirement for the Department to report findings, including projected costs, savings, and implementation timelines, to the Governor and General Assembly by December 1, 2025.

Added requirement for the Department to engage an independent consultant with experience in Medicaid fraud control and single PBM models to evaluate the transition.

Removed specific contract requirements including fiduciary duties, pass-through pricing, transparency requirements, and prohibition of spread pricing that were in the original Senate Substitute version.

Changed the bill from establishing a single PBM model to requiring an evaluation study of the potential benefits and costs of such a model.

Added requirement for Department to select and contract with a single third-party pharmacy benefits manager by December 31, 2027, to administer all pharmacy benefits for Medicaid recipients.

Added requirement for Department to engage an independent consultant by December 15, 2025 to evaluate implementation of a single pharmacy benefits manager contract.

Added effective date of January 1, 2027 for the pharmacy benefits manager provisions, contingent on federal approval.

Changed document header from House Substitute to Conference Substitute, indicating the bill has been reconciled between House and Senate versions.

Adjusted formatting and spacing throughout the document to reflect conference committee markup conventions.

The document changed from 'Enrolled' status (final) to 'Offered for Consideration' as a House substitute amendment dated February 11, 2025, indicating the bill is being reconsidered rather than enacted.

Formatting and page numbering were updated to reflect the substitute amendment format, with new page numbers and different header information.

The section numbering and formatting changed from continuous text to numbered lines with page breaks, typical of legislative substitute amendments.

A new requirement was added mandating that the Department engage an independent consultant with experience in Medicaid fraud control and single pharmacy benefits manager programs to assist with implementation, with the consultant prohibited from being engaged by managed care organizations or pharmacy benefits managers.

The deadline for the Department to select and contract with a state pharmacy benefits manager was changed from December 31, 2025 to December 31, 2026.

Removed a provision that would have prohibited business conflicts of interest for entities contracted as state pharmacy benefits managers.

Changed formatting from Engrossed legislative text to Enrolled format with page numbers, approval stamps, and official session headers.

Formatting changes including spacing adjustments, line breaks, and alignment of text elements between the introduced and engrossed versions.

Minor text adjustments to patron listings and bill identification numbers to reflect official engrossment status.