HB 226 Summary

• Establishes pharmacy benefits managers (PBMs) as a separate regulated entity requiring registration with the insurance director, with violations subject to maximum civil penalties per day.

• Creates a duty of care requiring PBMs to act in the best interest of plan sponsors and covered persons, disclose conflicts of interest, pass through manufacturer payments in full, and provide detailed drug pricing and financial arrangement information upon request.

• Prohibits unfair trade practices including spread pricing, claim reversals beyond 90 days without just cause, reimbursing affiliates at lower rates than non-affiliates, and interfering with patients' pharmacy choice or access to clinician-administered drugs.

• Requires PBMs to maintain searchable electronic drug lists with specific pricing details, ensure drugs meet FDA equivalence standards, update prices within one business day of significant changes, and exclude dispensing fees from pricing calculations.

• Takes effect January 1, 2025, with regulations to be adopted by the director of insurance; applies to insurance policies and PBM contracts issued or renewed on or after the effective date.