CA SB41

Prohibits pharmacy benefit managers (PBMs) from requiring use of only affiliated pharmacies, discriminating against non-affiliated pharmacies, or using spread pricing (charging health plans more than they pay pharmacies for drugs)

Requires PBMs to use a passthrough pricing model where payments from health plans equal payments to pharmacies, and limits PBM income to flat pharmacy benefit management fees not tied to drug prices or rebates

Mandates that 100% of prescription drug manufacturer rebates be directed to health plans or programs to offset patient cost sharing, deductibles, and premiums

Prohibits health plans and insurers from calculating patient cost sharing at amounts exceeding the actual rate paid for the prescription drug, effective for policies issued, amended, or renewed on or after January 1, 2026

Authorizes the Attorney General to recover civil penalties of $1,000-$7,500 per violation and seek injunctive relief for PBM licensing violations; requires PBMs contracting with health insurers to be licensed by the Department of Managed Health Care by January 1, 2027