DE HB284

Establishes comprehensive regulations for pharmacy benefit managers (PBMs) under Delaware Code Title 18, expanding beyond existing pharmacy audit integrity standards.

Requires PBMs using maximum allowable cost (MAC) pricing to disclose pricing sources to network pharmacies, update pricing at least every seven business days, and exclude dispensing fees from MAC calculations.

Allows contracted pharmacies to appeal MAC reimbursement within 10 calendar days if the reimbursement is less than the pharmacy's net cost, with PBMs required to respond within 10 calendar days.

Requires PBMs to provide denial reasons including national drug codes from Delaware wholesalers, and mandates that approved appeals result in price corrections applied retroactively to all similarly situated pharmacies.

Applies to pharmacy-PBM contracts entered into, renewed, or extended on or after January 1, 2017, and excludes the Department of Health and Human Services' fee-for-service Medicaid operations.