SB 742 Summary

• Requires managed care plans to include any pharmacy willing to accept reasonable terms and conditions in their networks, and prohibits exclusive reliance on mail-order pharmacies to meet network access standards.

• Mandates managed care plans publish the Agency for Health Care Administration's preferred drug list (not plan formularies) and update it within 24 hours of agency changes.

• Establishes requirements for pharmacy benefit managers (PBMs) in managed care, including reimbursement at National Average Drug Acquisition Cost (NADAC) plus $10.60 dispensing fee, use of agency-established preferred drug lists, and compliance with s. 624.490.

• Prohibits PBMs from charging pharmacies submission, enrollment, or processing fees; using spread pricing; creating indirect reimbursement reductions; requiring use of affiliate or mail-order pharmacies; retroactively denying or reducing claim payments; or excluding willing pharmacies.

• Transfers pharmacy audit provisions from section 465.1885 to 624.491, expands audit protections to apply to health insurers and PBMs, allows pharmacies to appeal audit findings, and makes health insurers/HMOs remain responsible for PBM violations; effective January 1, 2023.