SB1521 Summary

• Establishes new requirements for pharmacy benefit managers (PBMs) using maximum allowable cost (MAC) pricing, including mandatory disclosure of comprehensive MAC lists to contracting pharmacies in accessible electronic format.

• Requires PBMs to update MAC lists at least every seven days using current data sources and limits drugs on MAC lists to those rated A or B in the FDA Orange Book, generally available from wholesalers, and not obsolete.

• Creates an appeal process allowing independent pharmacies at least 14 business days to challenge MAC prices if they exceed wholesaler costs or the drug doesn't meet eligibility requirements; PBMs must decide appeals within 14 business days.

• Permits pharmacies to reverse and rebill denied MAC claims at the approved rate following successful appeals, and mandates adjustment of MAC prices within one calendar day of appeal decision.

• Moves enforcement authority from the Department of Health to the Department of Commerce and Consumer Affairs, increasing penalties to up to $10,000 per violation with authority to order corrective action and restitution.