HB 194 Summary

• Expands definitions in pharmacy benefits manager (PBM) regulations to include "drug shortage list," "maximum allowable cost list," "pharmacy benefits management services," and "purchaser."

• Requires PBMs placing drugs on maximum allowable cost lists to ensure drugs are not obsolete, temporarily unavailable, or on FDA drug shortage lists, and are available from at least one (if multi-manufacturer) or two (if single-manufacturer) wholesalers in Delaware.

• Mandates PBMs update maximum allowable cost pricing at least every 7 business days and provide contracted pharmacies electronic access to current pricing information.

• Establishes appeal process allowing contracted pharmacies to challenge reimbursement within 10 calendar days if payment is less than net amount paid to drug supplier, with PBM required to respond within 10 days and provide detailed denial reasons or adjust pricing for all similarly situated pharmacies.

• Creates registration system for PBMs with the Insurance Commissioner, requiring $150 registration and renewal fees, with provisions for examination, enforcement, fines up to $10,000 per violation, and anti-retaliation protections for pharmacies filing appeals or complaints.