SB99 Summary

• Expands Department of Insurance oversight of pharmacy benefits managers (PBMs) by establishing reimbursement benchmarks, requiring PBMs to reimburse in-network pharmacies at amounts at least equal to National Average Drug Acquisition Cost plus 2% or $25, whichever is less, plus a dispensing fee matching Alabama Medicaid rates.

• Prohibits PBMs from "steering" beneficiaries toward specific pharmacies (including PBM-affiliated pharmacies) through higher copayments, marketing practices, or restrictions on non-affiliated pharmacies; prevents requiring beneficiaries to use mail-order pharmacies or purchase brand-name drugs when lower-cost alternatives exist.

• Establishes civil action rights allowing pharmacies, health insurers, covered individuals, and beneficiaries to sue PBMs for violations, with damages of at least $1,000 per violation or treble actual damages (whichever is greater) for knowing violations, plus attorney fees and injunctive relief.

• Regulates PBM audit practices by limiting sample sizes to 150 prescriptions, requiring two-week advance notice, prohibiting audits during the first five days of each month, and restricting recoupment to actual overpayments caused by fraud or error, with rebates passed entirely to clients unless directed otherwise.

• Effective October 1, 2025; does not apply to specialty drugs or self-funded Employee Retirement Income Security Act plans.