DE HB219

Increases PBM registration and renewal fees from $150 to $1,000 to better reflect administrative costs and align with other states' fees.

Requires PBMs to provide reasonably adequate and accessible pharmacy networks and prohibits denial of preferred participation status to willing pharmacies accepting standard terms.

Prohibits PBMs from engaging in spread pricing, charging network participation fees, reimbursing pharmacists/pharmacies less than they reimburse themselves or affiliates, and retroactively denying claims except for fraud or duplicate payment.

Requires PBMs to report quarterly to the Insurance Commissioner on revenue sources, rebates distributed to insurers, rebate pass-throughs to patients at point of sale, and itemized payment amounts by pharmacy and product.

Allows pharmacies to decline dispensing if reimbursement is below pharmacy acquisition cost, and requires pharmacies to inform patients of the reason and provide alternative pharmacy locations.