HB 830

Pharmacy benefits managers; requirements; scope; report. Requires a pharmacy benefits manager to use the pass-through pricing model and prohibits a pharmacy benefits manager from deriving income from pharmacy benefits management services provided to a carrier except for income derived from a pharmacy benefits management fee. The bill prohibits a pharmacy benefits manager from (i) reversing and or resubmitting the claim of a pharmacist or pharmacy without meeting certain requirements, (ii) reducing any payment to a pharmacist or pharmacy to an effective rate of reimbursement, or (iii) retroactively denying or reducing a claim or aggregate of claims except under certain circumstances. The bill applies all of the requirements for pharmacy benefits managers to the state employee health plan and certain reporting requirements to the state pharmacy benefits manager. The bill requires the State Corporation Commission (the Commission) to annually prepare a report based on certain information that examines the overall impact of prescription drug costs on health care premiums in the Commonwealth. Additionally, the bill requires the Commission to examine the practice of carriers or pharmacy benefits managers requiring or inducing covered individuals to utilize pharmacy services at an affiliated pharmacy. The Commission is required to report its findings and recommendations to the General Assembly by December 1, 2026.