SB1618 Summary

• Health plans and pharmacy benefit managers must provide cost, benefit, and coverage data to covered individuals, their providers, or authorized third parties upon request by July 1, 2024.

• Data must be current within one business day of changes, provided in real time, and in easily accessible formats including electronic health records systems; facsimiles are not acceptable.

• Requests must use established industry standards from organizations like the National Council for Prescription Drug Programs, Accredited Standards Committee X12, or Health Level 7.

• Required data includes patient-specific eligibility information, prescription costs and benefits, cost-sharing variance by pharmacy, lower-cost alternatives, and utilization management requirements for any covered drug.

• Health plans and PBMs are prohibited from restricting prescriber communication about alternative treatments, cash prices, patient assistance programs, or preferred pharmacy options.