HB 240 Summary

• Prohibits contracts from restricting pharmacists, pharmacies, or pharmacy benefits managers from informing patients about less costly prescription drug alternatives, including prices without insurance coverage.

• Requires pharmacy benefits managers to register with the insurance director as third-party administrators and biannually renew their registration with a self-supporting fee.

• Establishes audit procedures limiting pharmacy audits to two-year lookback periods, requiring 10 business days' notice for on-site audits, capping audits at one per 12 months and 250 prescriptions per year unless fraud is alleged.

• Prohibits extrapolation methods for calculating overpayments or recoupments; requires audits based on actual overpayment amounts with pharmacy rights to appeal within 30 days and receive preliminary reports within 60 days and final reports within 120 days.

• Creates appeal process for multi-source generic drug reimbursement with 10-day resolution timeline and requires pharmacy benefits managers to provide drug pricing methodology, maintain updated pricing lists, and ensure dispensing fees are excluded from pricing calculations.