SB 1052 Summary

• Pharmacy benefits managers must ensure prescription drugs on maximum allowable cost lists meet three criteria: at least three generic equivalents exist, the drug is FDA-designated as therapeutically equivalent, and it is available from national or regional wholesalers and not obsolete or temporarily unavailable.

• Pharmacy benefits managers must remove drugs from maximum allowable cost lists within three business days of determining they no longer meet eligibility requirements.

• Contracts between pharmacy benefits managers and pharmacies or plan sponsors entered into on or after October 1, 2015 must disclose the methodology for determining maximum allowable costs, notification processes for list updates, and procedures for contesting costs.

• Pharmacy benefits managers must update maximum allowable cost lists at least every seven calendar days and establish an appeals process allowing pharmacies to contest costs within 60 days of initial claim submission, with determinations issued within 7 calendar days.

• Violations of these provisions result in fines of not less than $1,000 per violation; effective date October 1, 2015.