SB3095 Summary

• Expands regulation of pharmacy benefit managers (PBMs) in Hawaii by adding new definitions including "340B covered entity," "rebate," "spread pricing," and "contract pharmacy" to Chapter 431S.

• Prohibits PBMs from discriminating against 340B covered entities in reimbursement rates, conducting spread pricing (charging insurers different prices than what they pay pharmacies), or retroactively denying claims except for fraud, duplicate payment, improper rendering, or agreed-upon reductions.

• Requires PBMs to submit quarterly reports to the insurance commissioner detailing aggregate rebates received, rebates distributed to insurers, rebates passed to enrollees at point of sale, and amounts paid for pharmacist services.

• Increases PBM registration and renewal application fees from $140 to not exceed $200, and raises penalties for operating without registration from $500 per violation to at least $1,000 per day of violation.

• Authorizes the insurance commissioner to conduct audits of insurers and PBMs reimbursing 340B covered entities to ensure program integrity and appropriate reimbursement levels; effective July 1, 2021.